经peel-away鞘输尿管镜下钬激光整块切除合并尿道狭窄的膀胱肿瘤临床分析

Clinical analysis of peel-away sheath-assisted ureteroscopic holmium laser en bloc transurethral resection of bladder tumor accompanied by urethral stricture

目的:探讨经peel-away鞘输尿管镜下钬激光整块切除合并尿道狭窄的膀胱肿瘤的手术技巧与疗效。方法:回顾性分析8例非肌层浸润性膀胱肿瘤合并尿道狭窄男性患者的临床资料。患者术前无明显排尿困难症状,术中F26.5电切镜在除去外鞘后仍无法置入膀胱,改用peel-away鞘辅助下输尿管镜联合钬激光整块切除膀胱肿瘤。结果:所有患者手术均顺利完成,手术时间15~45 min,术中出血量2~20 mL,未出现闭孔反射及膀胱穿孔等并发症。随访6~30个月,患者均未出现排尿困难症状,膀胱镜检尿道狭窄无加重,肿瘤复发2例。结论:经peel-away鞘输尿管镜钬激光整块切除合并尿道狭窄的膀胱肿瘤是一种安全有效的方式。

Objective:To investigate the surgical technique and efficacy of peel-away sheath-assisted ureteroscopic holmium laser for en bloc transurethral resection of bladder tumor in urethral stricture patients.Methods:We retrospectively analyzed eight non-muscle-invasive bladder cancer patients with urethral stricture.Without pre-operative dysuria,the resectoscope was impassable in these patients.Thus,the procedure was converted to employ ureteroscopic holmium laser for en bloc transurethral resection,with the assistance of a F16 peel-away sheath.Results:All eight operations were successful.The operation time varied between 15-45 min,and the estimated amount of bleeding during the operation was 2-20 mL.Neither obturator nerve reflex nor bladder perforation was found in any patient.During a follow-up period of 6-30 months,no patient developed dysuria.None of the patient was found aggravation of urethral stricture,while two patients were found recurrences by cystoscope.Conclusion:Peel-away sheath-assisted ureteroscopic holmium laser en bloc transurethral resection is safe and effective for bladder cancer patients with urethral stricture.