經尿道膀胱腫瘤黏膜下切除術治療非肌層浸潤性膀胱癌的治療效果

Efficiacy and safety of transurethral sub mucosal en bloc dissection of bladder tumor with pin shaped electrode for Non-Muscule-Invasive Bladder Cancer

目的探討經尿道膀胱腫瘤黏膜下切除術(BTESD)治療非肌層浸潤性膀胱癌(NMIBC)的治療效果。方法選取2016年2月~2018年10月36例確診膀胱腫瘤患者,腫瘤臨床分期為Ta、T1(N0M0)期。採用經尿道膀胱腫瘤黏膜下切除術,術前進行膀胱鏡檢查,明確患者腫瘤部位、數量及大小等基本情況。術中採用針狀電極經尿道膀胱腫瘤黏膜下切除。患者手術時間、術中出血量、膀胱沖洗時間、尿管留置時間、住院時間及術後隨訪期復發率,所得資料進行統計學分析。結果36例患者均成功完成手術,無中轉開放手術,無輸血病例,無膀胱穿孔病例。手術時間20~40分鐘,平均30分鐘,術中基本無出血,無膀胱穿孔,無閉孔神經反射,無膀胱内液體外滲。留置導尿管1~3天,膀胱沖洗時間1~2天。完成隨訪30例,隨訪率83.3%,隨訪時間8~28月,復發率19.4%(7/36)。結論經尿道膀胱腫瘤黏膜下切除術切除術是安全、精確、有效,能提供足夠完整的病理標本,對腫瘤浸潤深度、切緣是否陽性進行準確評估,具有創傷小、併發症少、術後恢復快、腫瘤復發風險低等優點,是實現膀胱腫瘤腔内精準治療的理想方法。

Objective To discuss the Efficiacy and safety of transurethral sub mucosal en bloc dissection of bladder tumor(BTESD)with pin shaped electrode for non-muscle-invasive bladder cancer(NMIBC).Methods 36 cases from Feburary 2016 to October 2018 diagnosed as bladder cancer with clinical stage Ta,T1(N0M0)and treated withTransurethral BTESD were selected.Pre-operation cystoscopy performed to observe tumor location,number and size.Operation time,bleeding,bladder irrgation time,indwelling foley’s catheter time,complication and recurrence rate were evaluated.Results All cases underwent BTESD smoothly,no obvious bleeding,bladder perforation,obturator nerve reflex or extravasation of bladder fluid occurred.The operation time was 20-40mins,average 30 mins,indwelling catheter time was 1-3days,bladder irrigation time was 1-2days.30 patients made regular follow up,follow up rate was 83.3%,follow up period was from 8 months to 28 months,average 18 months,recurrance rate was 19.4%(7/36).Conclusion Transurethral BTESD is safe,accurate and efficient;can provide the complete pathological samples and make a precise evaluation of the tumor depth invasion and the positive margins.Transurethral BTESD is minimal invasive with less complications,faster recovery and low tumor recurrence rates.