980 nm红激光经尿道膀胱肿瘤整块切除与经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌的疗效比较

Comparison of Curative Effect Between 980 nm Red Laser Transurethral En-bloc Resection and Transurethral Resection for Non-muscle Invasive Bladder Cancer

目的比较980 nm红激光经尿道膀胱肿瘤整块切除与经尿道膀胱肿瘤电切术(transuretheral resection of bladder tumor,TUR-Bt)治疗非肌层浸润性膀胱癌(non-muscle invasive bladder cancer,NMIBC)的安全性和有效性。方法回顾性分析2017年4月~2019年9月我院144例NMIBC的临床资料,体内有金属植入物者行980 nm红激光经尿道膀胱肿瘤整块切除(980 nm红激光组,n=68),其余行TUR-Bt(TUR-Bt组,n=76),术后均接受规范性膀胱灌注治疗。比较2组手术时间、膀胱冲洗时间、保留导尿时间、术后住院时间和闭孔神经反射、膀胱穿孔等围手术期并发症发生情况。结果2组均顺利完成手术,其中980 nm红激光组无一例中转开放手术,TUR-Bt组2例中转开放手术。980 nm红激光组手术时间(21.6±3.8)min,与TUR-Bt组(22.3±3.2)min差异无统计学意义(t=1.200,P=0.195)。980 nm红激光组膀胱冲洗例数及时间、导尿管留置时间、住院时间均明显少于/短于TUR-Bt组(P<0.05)。TUR-Bt组分别有8、5例发生闭孔神经反射及膀胱穿孔,980 nm红激光组无一例发生闭孔神经反射及膀胱穿孔,2组差异有统计学意义(P=0.005,P=0.038)。术后病理证实均为非肌层浸润性尿路上皮癌。2组患者术后随访12个月,980 nm红激光组复发2例,TUR-Bt组复发4例,2组肿瘤复发率无统计学差异(χ^(2)=0.078,P=0.081)。结论980 nm红激光整块切除法治疗NMIBC安全、有效。与TUR-Bt相比,980 nm红激光围手术期并发症少,可获得精确病理分期,肿瘤复发率相似。

Objective To compare the safety and efficacy of 980 nm red laser transurethral en-bloc resection of bladder tumor and transurethral resection of bladder tumor(TUR-Bt)in the treatment of non-muscle invasive bladder cancer(NMIBC).MethodsThe clinical information of 144 patients with NMIBC from April 2017 to September 2019 were analyzed retrospectively.Patients with metal implants underwent 980 nm laser transurethral resection(980 nm red laser group,n=68),and the rest underwent TUR-Bt(TUR-Bt group,n=76).All the patients received standard bladder perfusion therapy after operation.The operation time,bladder irrigation time,catheterization time,hospitalization time,and peri-operative complications such as obturator nerve reflex and bladder perforation were recorded and analyzed.Results All the patients underwent the operation successfully.There was no conversion to open surgery in the 980 nm red laser group and 2 cases in the TUR-Bt group.The operation time of the 980 nm red laser group was(21.6±3.8)min,which was not significantly different from that of the TUR-Bt group[(22.3±3.2)min,t=1.200,P=0.195].The number and time of bladder irrigation,catheter indwelling time and hospitalization time in the 980 nm red laser group were significantly lower/shorter than those in the TUR-Bt group(P<0.05).The obturator nerve reflex and bladder perforation occurred in 8 cases and 5 cases respectively in the TUR-Bt group,whereas none in the 980 nm red laser group,with significant differences between the two groups(P=0.005,P=0.038).Postoperative pathology confirmed non-myometrial invasive urothelial carcinoma.The patients in the two groups were followed up for 12 months.There were 2 cases of recurrence in the 980 nm red laser group and 4 cases in the TUR-Bt group.There was no significant difference in the tumor recurrence rate between the two groups(χ^(2)=0.078,P=0.081).Conclusions Use of 980 nm laser en-bloc resection is a safe and effective treatment for NMIBC.As compared with TUR-Bt,980 nm laser has fewer perioperative complications and accurate pathological staging,and the tumor recurrence rate is similar.