窄带成像技术同期联合绿激光治疗非肌层浸润性膀胱肿瘤的疗效观察

Narrow band imaging combined with green laser in the treatment of non-muscle invasive bladder tumor

目的探讨窄带成像技术(NBI)同期联合绿激光治疗非肌层浸润性膀胱肿瘤(NMIBC)的安全性和临床疗效。方法 2015年3月~2018年5月收治的非肌层浸润性膀胱肿病人63例,均接受绿激光手术,随访满2年,按手术方法分为两组:NBI组33例,接受NBI同期联合绿激光手术;普通白光模式内镜(WLI)组30例,接受WLI下绿激光手术。对两组术中发现的病变数目、获取的病理标本数目、病理结果,术后留置尿管时间,术后住院时间,术中、术后并发症,术后2年内复发率等进行对比分析。结果 NBI组术中发现的人均病变数目及获取的病理标本总数量多于WLI组[(2.4±1.4)处/例,共95份vs (1.3±0.5)处/例、共61份],差异有统计学意义(P<0.05),手术病理结果均以低级别尿路上皮癌为主。WLI组手术时间短于NBI组[(29.4±17.9)分钟和(49.1±21.8)分钟,差异有统计学意义(P<0.05)。两组术后留置尿管时间、术后在院时间比较,差异无统计学意义(P>0.05)。NBI组的并发症发生率高于WLI组(18.2%和16.7%),差异有统计学意义(P<0.05),主要为膀胱痉挛。NBI组的2年复发率明显低于WLI组(3.0%和10.0%),差异有统计学意义(P<0.05),且NBI组复发均在1年之后非原位复发。结论 NBI同期联合绿激光对于NMIBC的治疗安全有效,可降低术后复发率。

Objective To investigate the safety and clinical efficacy of narrow band imaging(NBI) combined with green laser in the treatment of non-muscle invasive bladder tumor(NMIBC).Methods The data of 63 patients with NMIBC who were diagnosed in our hospital from March 2015 to May 2018 and underwent green laser surgery and were followed up for 2 years were retrospectively analyzed.According operation method they were divided into 2 groups: NBI group(33 cases) received NBI combined with green laser surgery and WLI group(30 cases) received green laser surgery under WLI(white light imaging).The number of pathological changes found in the operation, the number of pathological specimens obtained, pathological results, postoperative indwelling catheter time, postoperative hospital stay, intraoperative and postoperative complications, postoperative recurrence rate within 2 years were compared between the two groups.Results The number of lesions per capita and the total number of pathological specimens obtained in NBI group were more than those in WLI group(2.4±1.4/person, 95 cases vs 1.3±0.5/person, 61 cases, P<0.01).Low grade urothelial carcinoma was the main pathological result.The operation time of WLI group was shorter than that of NBI group[(29.4±17.9)min vs(49.1±21.8)min, P<0.01].There was no significant difference in indwelling catheter time and postoperative hospital stay between two groups(P>0.05).The incidence of complications in group NBI was higher than that in group WLI(18.2% vs 16.7%,P<0.01),and the main complication was bladder spasm.The 2-year recurrence rate of group NBI was significantly lower than group WLI(3.0% vs 10.0%,P<0.01),and the recurrence case in group NBI was not in situ recurrence after 1 year.Conclusion NBI combined with green laser in the treatment of NMIBC is safe and effective.It can reduce the recurrence rate, and simple to operate.It is worthy of further clinical research and promotion.