经尿道等离子针状电极整块切除与环状电极电切治疗膀胱肿瘤疗效及安全性比较

Comparison of the efficacy and safety of transurethral plasma needle electrode resection and transurethral plasma ring electrode resection for the treatment of bladder cancer

目的:比较经尿道等离子针状电极整块切除非肌层浸润性膀胱癌与经尿道等离子环状电极电切治疗非肌层浸润性膀胱癌的疗效和安全性。方法:经尿道等离子针状电极整块切除非肌层浸润性膀胱癌和经尿道等离子环状电极电切治疗非肌层浸润性膀胱癌各25例,比较两组患者年龄、性别、肿瘤部位、肿瘤大小、肿瘤数目、肿瘤分级、手术时间、闭孔神经反射发生例数、膀胱穿孔例数、肿瘤标本显示肌层例数、肿瘤复发例数和手术后随访时间。结果:两组患者年龄、性别、肿瘤部位、肿瘤大小、肿瘤数目、肿瘤分级、手术时间、膀胱穿孔例数、肿瘤复发例数和手术后随访时间比较无显著差异(P>0.05),经尿道等离子针状电极整块切除非肌层浸润性膀胱癌组显示膀胱肿瘤基底肌层22例,经尿道等离子环状电极电切显示膀胱肿瘤基底肌层3例,前组可比后组显示更多的膀胱肿瘤基底肌层患者(P<0.05)。经尿道等离子针状电极整块切除非肌层浸润性膀胱癌组发生闭孔神经反射1例,经尿道等离子环状电极电切组发生8例,前组发生闭孔神经反射发生率明显低于后组(P<0.05)。结论:经尿道等离子针状电极整块切除术与经尿道等离子环状电极电切治疗非肌层浸润性膀胱癌均安全、有效。但前组比后组闭孔神经反射发生率更少(P<0.05);前组比后组可获得更多的肿瘤基底肌层标本(P<0.05),更有利于病理分期。

Objective:To compare the efficacy and safety of transurethral plasma needle electrode resection and transurethral plasma ring electrode resection for the treatment of non-muscular invasive bladder cancer.Methods:A total of 50 cases were enrolled in this study,and were divided into 2 groups according to the surgical methods(transurethral plasma needle electrode resection vs transurethral plasma ring electrode resection).Each group enrolled 25 cases.Parameters such as age,gender,tumor site,tumor size,tumor number,tumor grade,operative time,incidence of obturator nerve reflex,bladder perforation,muscle layer identified in specimens,recurrence and follow-up time were compared between 2 groups.Results:There was no significant difference in age,gender,tumor site,tumor size,tumor number,tumor grade,operative time,bladder perforation,recurrence,and postoperative follow-up time between the two groups(P>0.05).In the whole resection of non-muscular-invasive bladder cancer group with transurethral plasma needle electrode,22 cases were identified muscle layer in specimens,while only 3 cases showed muscle layer in specimens using transurethral plasma needle electrode resection technique(P<0.05).In the transurethral plasma needle electrode resection group for non-muscular invasive bladder cancer,obturator nerve reflex occurred in 1 patient,and 8 cases were observed obturator nerve reflex in the transurethral plasma ring electrode resection group,the incidence of obturator nerve reflex was significantly lower using transurethral plasma needle electrode resection(P<0.05).Conclusion:Transurethral plasma needle electrode resection and transurethral plasma ring electrode resection are both safe and effective in the treatment of non-muscular invasive bladder cancer.However,the incidence of obturator nerve reflex in the transurethral plasma needle electrode resection group is less than that in the transurethral plasma ring electrode resection group(P<0.05),and the former group can obtain more tumor basilar layer specimens than the latter group(P<0.05),which is more conducive to pathological staging.