Nd:YAG激光经尿道膀胱肿瘤整块切除术的临床疗效

Clinical Effect of Transurethral En Bloc Resection of Bladder Tumor with Nd:YAG Laser

目的研究Nd:YAG激光用于经尿道膀胱肿瘤整块切除术的临床疗效。方法回顾性分析2017年1月至2019年6月,非肌层浸润性膀胱肿瘤患者45例的临床资料,按照手术方法不同分为两组,分别为Nd:YAG激光组(A组),患者22例,采用经尿道Nd:YAG激光治疗,功率80 W;等离子柱状电极组(B组),患者23例,采用等离子柱状电极膀胱肿瘤整块切除术,电切功率160 W,电凝功率80 W。比较两组患者围手术期相关指标和临床疗效。结果激光组86.4%(19/22)患者及等离子柱状电极组87.0%(20/23)患者手术标本包含膀胱肌层组织。激光组无患者出现闭孔神经反射,等离子柱状电极组2例患者出现闭孔神经反射。两组患者的手术时间、术后膀胱冲洗时间比较,差异无统计学意义(P>0.05);两组患者术中和术后均无出血,无膀胱穿孔等严重并发症发生。随访11~47个月,中位26个月,激光组和等离子电极组各有2例患者出现肿瘤复发,两组复发率比较差异无统计学意义(P>0.05)。结论Nd:YAG激光经尿道膀胱肿瘤整块切除术中安全、有效。术中可清楚分辨切除平面中的黏膜层、浅肌层、深肌层,为组织病理学检查提供良好的标本,可增加术后判定病理分期的准确性。

Objective To study the clinical effect of Nd-YAG laser in transurethral en bloc resection of bladder tumor.Methods The clinical data of 45 patients with non-muscle invasive bladder tumor from Jan.2017 to Jun.2019 were retrospectively analyzed.They were divided into two groups by surgical methods:the Nd-YAG laser group(Group A),which consisted of 22 patients treated with transurethral Nd-YAG laser(power:80 W),and the plasma columnar electrode group(Group B),which consisted of 23 patients treated with plasma column electrode for bladder tumor resection(cutting power:160 W,and coagulation power:80 W).Results 86.4%(19/22)of the patients in the laser group and 87.0%(20/23)of the patients in the plasma electrode group showed bladder muscle layer pathologically.There was no obturator nerve reflex found in the laser group,but obturator nerve reflex occurred to 2 patients in the plasma group.Comparison of operation time and postoperative bladder irrigation time between the two groups showed no significant difference(P>0.05).No major complication such as massive hemorrhage and bladder perforation occurred in either group during or after the operation.The patients were followed up for 11-47 months,and the median was 26 months.Tumor recurrence occurred to 2 patients in the laser group and 2 patients in the plasma electrode group,and there was no significant difference in recurrence rate between the two groups(P>0.05).Conclusions The application of Nd-YAG laser in transurethral en bloc resection of bladder tumor is safe and effective.Mucosal layer,superficial muscular layer and deep muscular layer can be clearly distinguished during the operation.It will also provide good specimens for pathological examination and help accurate pathological staging.