“牵牛”法辅助经尿道膀胱肿瘤整块切除术的临床应用

Clinical application of transurethral resection of bladder tumor assisted by"lead cow method"

目的:探讨经耻骨上膀胱穿刺建立辅助通道,牵引肿瘤后经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的临床效果。方法:选取我院2017年03月到2019年02月收治的72例非肌层浸润性膀胱癌患者,随机分为对照组和研究组,各36例。对照组采取标准的经尿道膀胱肿瘤整块切除术,研究组先经正中线耻骨上2指处穿刺建立2~5 mm操作通道,置入长钳至膀胱,尿道镜监视下钳夹膀胱肿瘤基底部周围组织,适当牵拉。在牵拉张力下,黏膜下各层组织结构清晰可辨,沿肿瘤周围2 cm处切开黏膜至深肌层,沿深肌层推进并扩展,直至整块化切除肿瘤,肿瘤组织利用组织篮套取出。比较分析两组患者的手术时间、血红蛋白降低值,并发症及肿瘤复发率等。结果:所有手术均顺利完成,两组患者术后血红蛋白无明显变化。和对照组比较,研究组手术时间明显缩短,肿瘤基底部浅肌层完整,闭孔神经反射和膀胱穿孔、肿瘤复发率明显降低(P<0.05)。结论:“牵牛”法辅助经尿道膀胱肿瘤整块切除术可以稳定、清晰、灵活地显露肿瘤基底部组织,提高膀胱肿瘤完整切除率,减少手术并发症,且操作简单,安全可靠。

Objective:To observe the clinical effect of transurethral bladder tumor mass resection for the treatment of non-muscle invasive bladder cancer after the suprapubic bladder puncture to establish auxiliary channels.Methods:A total of 72 patients with non-muscular invasive bladder cancer treated in our hospital from March 2017 to February 2019 were randomly divided into a control group and a study group,with 36 cases in each.The standard transurethral resection of bladder tumor was performed in the control group.In the study group,the 2~5 mm operation channel was established by puncturing at the 2 fingers superior to the midline pubic bone,and the long forceps were placed into the bladder.Under the monitoring of urethroscope,the tissue around the base of bladder tumor was clamped and pulled properly.With the traction tension,the tissue structure of each submucosal layer was clearly discernible.We cut the mucosa along the 2 cm around the tumor to the deep muscle layer,promoted and expanded along the deep muscle layer until the tumor was resected as a whole,and then the tumor tissue was removed by tissue sleeve.The operation time,hemoglobin reduction,complications and tumor recurrence rate of the two groups were compared and analyzed.Results:All operations were completed successfully,and there was no significant change in hemoglobin between the two groups.Compared with the control group,the operation time was significantly shortened,the superficial muscle layer at the base of the tumor was intact in the study group.The obturator nerve reflex,bladder perforation and tumor recurrence rate in the study group were significantly lower than those in the control group(P<0.05).Conclusion:Transurethral resection of bladder tumor assisted by"lead cow method"can stably,clearly and flexibly expose the basal tissue of bladder tumor,improve the complete resection rate of bladder tumor and reduce the operative complications.The operation is simple,safe and reliable.