经尿道钬激光切除术治疗非肌层浸润性膀胱癌的效果及对血清MMPs和VEGF水平的影响

Effect of transurethral holmium laser resection on non-muscular invasive bladder cancer and its influence on levels of MMPs and VEGF in serum

目的探讨经尿道钬激光膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的效果及对血清基质金属蛋白酶(MMPs)、血管内皮生长因子(VEGF)水平的影响。方法采用前瞻性研究,抽取2019年3月至2020年5月河南省人民医院治疗的80例非肌层浸润性膀胱癌患者,采用随机数字表法分为对照组和观察组,每组40例。对照组采用经尿道膀胱肿瘤切除术(TURBT)治疗,观察组采用经尿道钬激光膀胱肿瘤切除术治疗,术后两组均给予吡柔比星膀胱内灌注治疗。比较两组手术相关指标,手术前后血清基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)、VEGF水平,术后并发症发生率及术后1年内复发率。结果与对照组比较,观察组手术时间、导尿管留置时间及住院时间均缩短,术中出血量减少(P<0.05)。术后3个月,两组患者血清MMP-2、MMP-9及VEGF水平均低于术前,且观察组低于对照组(P<0.05)。观察组术后并发症总发生率(2.50%,1/40)低于对照组(17.50%,7/40),术后1年内复发率(5.00%,2/40)低于对照组(17.50%,7/40),P<0.05。结论与TURBT比较,经尿道钬激光膀胱肿瘤切除术可更有效地降低非肌层浸润性膀胱癌患者术后血清MMPs及VEGF水平,降低术后复发率,其对患者造成的损伤更小,且术后并发症少,安全性高。

Objective To investigate the efficacy of transurethral holmium laser bladder tumor resection on non-muscular invasive bladder cancer and its influence on serum matrix metalloproteinases(MMPs)and vascular endothelial growth factor(VEGF)levels.Methods Eighty patients with non-muscular invasive bladder cancer treated in Henan Provincial People’s Hospital from March 2019 to May 2020 were selected for the prospective study,and they were divided into control group and observation group according to the random number table method,with 40 cases in each group.The control group was treated by transurethral resection of bladder tumour(TURBT),while the observation group was treated by transurethral holmium laser bladder tumor resection.And both groups were given pirarubicin intravesical perfusion treatment after surgery.The operation-related indicators,preoperative and postoperative levels of serum matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9)and VEGF,postoperative complications and recurrence rate within 1 year after operation were compared between the two groups.Results Compared with the control group,the operation time,catheter retention time and hospital stay in the observation group were significantly shortened,and intraoperative blood loss was significantly reduced(P<0.05).Compared with preoperative levels,the levels of serum MMP-2,MMP-9 and VEGF of the two groups decreased 3 months after operation,and the levels of observation group was lower than those of the control group(P<0.05).The incidence of postoperative complications in the observation group(2.50%,1/40)was lower than that in the control group(17.50%,7/40),and the recurrence rate within 1 year after operation(5.00%,2/40)was lower than that in the control group(17.50%,7/40),P<0.05.Conclusions Compared with TURBT,transurethral holmium laser bladder tumor resection can more effectively reduce postoperative serum MMPs and VEGF levels in patients with non-muscular invasive bladder cancer,reduce postoperative recurrence rate,and cause less impair on patients and fewer postoperative complications,with high safety.