经尿道针状电极精准切除治疗非肌层浸润性膀胱癌

Accurate transurethral needle-electrode resection in the management of non-muscle invasive bladder cancer

目的比较经尿道针状电极精准切除(ATUNER)和经尿道膀胱肿瘤切除术(TURBT)治疗非肌层浸润性膀胱癌(NMIBC)的疗效和安全性,并观察术后随访结果。方法将2017年3月至2019年5月陕西省宝鸡市中心医院收治的NMIBC患者随机分为ATUNER组和TURBT组。两组患者术后均接受规律膀胱灌注化疗,收集并比较两组患者术前、术中、术后随访资料。结果160例患者完成研究,ATUNER组和TURBT组各80例,两组患者均顺利完成手术。两组一般资料及肿瘤学特征比较差异均无统计学意义(P>0.05)。ATUNER组和TURBT组手术时间[(23.96±14.04)min vs.(24.03±12.84)min]相比,差异无统计学意义(P>0.05)。ATUNER组和TURBT组的术后膀胱冲洗时间[(13.23±4.64)h vs.(16.79±6.51)h]、术后留置导尿管时间[(2.56±1.18)d vs.(3.14±1.44)d]、术后住院时间[(3.55±1.15)d vs.(4.13±1.42)d]相比,差异有统计学意义(P<0.05)。ATUNER组术中有5例发生闭孔神经反射,2例出现膀胱穿孔,而TURBT组分别为15例和9例,差异有统计学意义(P<0.05)。ATUNER组术后病理标本中逼尿肌检出率(97.5%)显著高于TURBT组(67.5%)(P<0.05)。ATUNER组术后24个月复发率(8.75%)低于TURBT组(28.75%)(P<0.05)。结论ATUNER治疗NMIBC的临床有效性较TURBT显著,并发症发生率及二次电切率降低,标本质量较高,是一项安全、有效的技术,值得临床推广。

Objective To compare the safety and efficacy of accurate transurethral needle-electrode resection(ATUNER)and conventional monopolar transurethral resection of bladder tumor(TURBT)in the management of non-muscle invasive bladder cancer(NMIBC),and to investigate the follow-up results.Methods The NMIBC patients treated during Mar.2017 and May 2019 were randomly divided into ATUNER group and TURBT group.All patients received regular intravesical chemotherapy after surgery.The pre-,intra-and post-operative data were recorded and compared.Results A total of 160 patients were included,with 80 in either group.All operations were successful.There were no differences in the general data and tumor features between the two groups(P>0.05).The operation time was(23.96±14.04)min in ATUNER group and(24.03±12.84)min in TURBT group(P>0.05).There were significant differences in the postoperative bladder irrigation time[(13.23±4.64)vs.(16.79±6.51)h],catheter indwelling time[(2.56±1.18)vs.(3.14±1.44)d)and postoperative hospital stay(3.55±1.15 vs.4.13±1.42 days)between the two groups(P<0.05).In ATUNER group,obturator nerve reflex occurred in 5 cases and bladder perforation occurred in 2 cases,while in TURBT group,obturator nerve reflex occurred in 15 cases and bladder perforation occurred in 9 cases,with statistical significance(P<0.05).Detrusor muscle was found in 97.5%cases in ATUNER group,higher than in 67.5%cases in TURBT group(P<0.05).The 24-month recurrence rate in ATUNER group was 8.75%,significantly lower than 28.75%in TURBT group(P<0.05).Conclusion ATUNER has better efficacy than TURBT in the treatment of NMIBC.It decreases the complication rate,reduces the need for second TURBT and provides high-quality specimens for histopathological evaluation.Safe and effective,it is worth popularizing in clinical practice.