海博刀经尿道内镜黏膜下膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效

Efficacy of transurethral endoscopic submucosal en bloc resection of bladder tumor with Hybrid knife in the treatment of non-musculoinvasive bladder cancer

目的探讨应用海博刀经尿道内镜黏膜下膀胱肿瘤整块切除术(ERBT)治疗非肌层浸润性膀胱癌(NMIBC)的临床疗效。方法选取本院2019年3月至2021年1月收治的128例NMIBC患者作为研究对象,按照随机数字表法分为ERBT组和经尿道膀胱肿瘤电切术(TURBT)组,每组各64例。比较两组手术相关指标、术后并发症以及复发情况。结果ERBT组患者的膀胱冲洗时间、尿管留置时间和术后住院时间均短于TURBT组(均P<0.05)。ERBT组患者的术后出血、闭孔神经反射、膀胱穿孔的发生率均低于TURBT组(均P<0.05)。ERBT组的逼尿肌检出率为98.4%(63/64),TURBT组的逼尿肌检出率为62.5%(40/64),两组差异有统计学意义(P<0.05)。随访18个月,ERBT组术后6个月、6~12个月、12~18个月的复发率低于TURBT组,差异均有统计学意义(均P<0.05)。ERBT组患者的总复发率为6.3%(4/64),TURBT组的总复发率为21.9%(14/64),两组差异有统计学意义(P<0.05)。结论应用海博刀经尿道内镜黏膜下ERBT治疗NMIBC安全有效,能明显降低术后复发率,值得临床推广应用。

Objective To investigate the clinical efficacy of transurethral endoscopic submucosal en bloc resection of bladder tumor(ERBT)with Hybrid knife in the treatment of non-musculoinvasive bladder cancer(NMIBC).Methods A total of 128 cases of NMIBC were selected in our hospital from March 2019 to January 2021.According to the random number table method,the patients were divided into ERBT group and TURBT group,64 cases in each group.Operation indicators,postoperative complications and recurrence rates in two groups were compared.Results The bladder irrigation time,catheter indwelling time and postoperative hospital stay in ERBT group were shorter than those in TURBT group(all P<0.05).The incidence of postoperative bleeding,obturator nerve reflex and bladder perforation in the ERBT group was lower than that in the TURBT group(all P<0.05).The detection rate of detrusor was 98.4%in ERBT group and 62.5%in TURBT group,and the difference was statistically significant(P<0.05).After 18 months of follow-up,the recurrence rate of ERBT group at 6 months,6-12 months and 12-18 months after surgery was lower than that of TURBT group,and the differences were statistically significant(all P<0.05).The total recurrence rate of ERBT group was 6.3%,and that of TURBT group was 21.9%,and the difference was statistically significant(P<0.05).Conclusions Transurethral endoscopic submucosal ERBT with Hybrid knife in the treatment of NMIBC is safe and effective in the treatment of non-muscle-invasive bladder cancer,which can significantly reduce the postoperative recurrence rate,and is worthy of promotion and application.