浅析黏膜下注射分离技术辅助针状电极剜除术治疗非肌层浸润性膀胱癌

The analysis of endoscopic dissection assisted submucosal injection separation technique in the treatment of non-muscular invasive bladder cancer

目的评估黏膜下注射分离技术辅助针状电极剜除术治疗非肌层浸润性膀胱癌(NMIBT)的安全性及临床疗效。方法回顾性分析本院2012年1月至2020年1月收治的67例NMIBT患者的临床资料,根据不同的手术方式将患者分成三组:其中行传统经尿道膀胱肿瘤电切术(TURBT)治疗患者设为对照组(23例),行经尿道膀胱肿瘤剜除术(TUERBT)患者设为观察A组(21例),行黏膜下注射分离技术辅助针状电极剜除术患者设为观察B组(23例)。比较三组患者的基线资料、手术时间、术中失血量、膀胱冲洗时间、住院时间;比较三组患者的膀胱穿孔、闭孔神经反射、膀胱刺激征等手术并发症情况及术后二次活检阳性率和预后复发情况。结果观察B组的术中失血量明显少于对照组(P<0.05),手术时间长于对照组(P<0.05),膀胱冲洗时间、术后住院时间明显短于对照组(P<0.05),膀胱穿孔、闭孔神经反射、膀胱刺激征及血尿发生率均明显低于对照组(P<0.05);观察A组的手术时间、术后住院时间和膀胱冲洗时间与对照组比较,差异无统计学意义(P>0.05),但术中失血量明显少于对照组(P<0.05),膀胱穿孔、闭孔神经反射发生率低于对照组(P<0.05);观察B组的闭孔神经反射发生率及膀胱刺激征发生率均显著低于观察A组(均P<0.05)。观察B组和A组患者术后12个月的活检阳性率显著低于对照组(P<0.05)。结论黏膜下注射分离技术辅助针状电极剜除术治疗NMIBT相比TURBT和TUERBT更加安全有效,且并发症较少,复发率低,设备门槛低,值得临床推广应用。

Objective To evaluate the safety and clinical efficacy of submucosal injection separation technique assisted needle electrode enucleation in the treatment of non-muscular invasive bladder cancer(NMIBT).Methods From January 2012 to January 2020,clinical data of 67 patients with NMIBT in our hospital were retrospectively analyzed.The three groups were made according to the choice of different surgical approach.Among them,patients treated with traditional transurethral resection of bladder tumor(TURBT)were set as control group(23 cases),patients treated with transurethral resection of bladder tumor(TUERBT)were set as observation group A(21 cases),and patients treated with needlelike electrode resection assisted by submucosal injection separation technology were set as observation group B(23 cases).The basic information,operation time,blooding,and the staying of postoperative hospital in three groups were compared.Bladder perforation,obturator nerve reflex,bladder irritation and other surgical complications were compared among the three groups,and the positive rate of secondary biopsy and prognosis recurrence were compared.Results The blood loss in observation group B was significantly lower than that in the control group(P<0.05),the operation time was longer than that in the control group(P<0.05),the postoperative hospitalization time was significantly shorter than that in the control group(P<0.05),and the incidence of bladder perforation,obturator nerve reflex,bladder irritation and postoperative recurrence rate were significantly lower than that in the control group(P<0.05).The operative time and postoperative hospital stay of observation group A were not significantly different from that of the control group(P>0.05),but the blood loss was significantly lower than that of the control group(P<0.05),and the incidence of bladder perforation and obturator nerve nerve reflex was lower than that of the control group(P<0.05).The incidence of obturator nerve reflex and postoperative recurrence in observation group B were significantly lower than those in observation group A(all P<0.05).The positive rate of biopsy in observation group B 12 months after operation was significantly lower than that in control group(P<0.05).Conclusions Compare with TURBT and TUERBT,submucosal injection separation technology assisted needle electrode enucleation for NMIBT is safe and effective,that is come with fewer complications,low recurrence rate and little equipment.It is worthy for clinical promotion.