钬激光治疗非肌层浸润性膀胱肿瘤的疗效及安全性

Efficacy and safety of holmium laser in the treatment of non-muscular invasive bladder tumors

目的探讨经尿道钬激光膀胱肿瘤切除术(HoLRBT)治疗非肌层浸润性膀胱肿瘤的疗效及安全性。方法选择2017年1月至2020年1月在本院进行手术治疗的82例非肌层浸润性膀胱癌(<T2期)患者,其中40例患者采用经尿道钬激光膀胱肿瘤切除术治疗(HoLRBT组),42例患者采用经尿道膀胱肿瘤电切术(TURBT)治疗(TURBT组)。观察两组的各项临床指标、并发症、术后病理及复发情况。结果HoLRBT组的膀胱冲洗时间、术后留置导尿管时间及住院时间均明显短于TURBT组,差异均有统计学意义(均P<0.05)。HoLRBT组术中未发生闭孔神经反射,有1例患者发生膀胱穿孔;TURBT组术中有6例患者发生闭孔神经反射,2例患者发生膀胱穿孔;HoLRBT组术后病理中有肌层组织情况及术后肿瘤残留率明显优于TURBT组(P<0.05)。随访两年,两组的肿瘤累积复发率比较,差异无统计学意义(12.5%vs.19.0%,P>0.05)。结论HoLRBT治疗T2期以内的膀胱肿瘤是一种安全、有效的手术方式,可以减少术后肿瘤残留,避免行二次电切除术。

Objective To evaluate the efficacy and safety of transurethral holmium laser resection of bladder tumors(HoLRBT)in the treatment of non-muscular invasive bladder tumors.Methods From January 2017 to January 2020,82 patients with non-muscular invasive bladder cancer underwent surgical treatment in our hospital.Among them,40 patients were treated with HoLRBT(HoLRBT group)and 42 patients were treated with transurethral resection of bladder tumor(TURBT group).The clinical indicators,complications,postoperative pathology and recurrence were observed.Results There was no significant difference in operation time between two groups(P>0.05).Bladder irrigation time,indwelling catheter time and hospitalization time in HoLRBT group were significantly shorter than those in TURBT group,and the difference was statistically significant(all P<0.05).There was no obturator nerve reflex and one bladder perforation in HoLRBT group.In TURBT group,6 cases had obturator nerve reflex,2 cases had bladder perforation.The postoperative pathology of HoLRBT group was better than that of TURBT group,and the postoperative tumor residue rate was lower than that of TURBT group.Followed up for two years,there was no significant difference in the cumulative recurrence rate between the two groups(P>0.05).Conclusions HoLRBT is a safe and effective method for the treatment of bladder cancer within stage T2.