经尿道钬激光剜除术与经尿道膀胱肿瘤电切术对非肌层浸润性膀胱癌的疗效比较

Effect of transurethral holmium laser enucleation versus transurethral resection of bladder tumor in treating non-muscle invasive bladder cancer

目的比较经尿道钬激光剜除术(HOLRBT)与经尿道膀胱肿瘤电切术(TURBT)对非肌层浸润性膀胱癌(NMIBC)的疗效。方法回顾性分析93例NMIBC患者的临床资料,根据手术方式的不同分为HOLRBT组42例和TURBT组51例。比较2组患者围术期指标、手术前后肿瘤相关因子[血管内皮生长因子(VEGF)、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)]水平和随访期间并发症发生情况、复发率、无瘤生存率。结果与TURBT组比较,HOLRBT组手术时间、住院时间、留置尿管时间更短,术中出血量更少,住院费用更高,差异有统计学意义(P<0.05);术后7 d时,HOLRBT组VEGF、IGF-Ⅰ水平低于TURBT组,差异有统计学意义(P<0.05);随访期间,HOLRBT组并发症发生率、复发率依次为4.76%、11.90%,分别低于TURBT组的19.61%、33.33%,HOLRBT组无瘤生存率为54.76%,高于TURBT组的31.37%,差异有统计学意义(P<0.05)。结论相较于TURBT,HOLRBT治疗NMIBC可以改善围术期指标,抑制致癌因子表达,降低并发症发生风险和复发率,提高无瘤生存率。

Objective To compare the curative effect of transurethral holmium laser resection of bladder tumor(HOLRBT)and transurethral resection of bladder tumor(TURBT)on non-muscle invasive bladder cancer(NMIBC).Methods A retrospective analysis was performed on the clinical data of 93 patients with NMIBC.According to different surgical methods,they were divided into HOLRBT group(42 cases)and TURBT group(51 cases).The perioperative indexes,levels of tumor-related factors[vascular endothelial growth factor(VEGF),insulin-like growth factor-Ⅰ(IGF-Ⅰ)]before and after surgery,incidence of complications,recurrence rate and disease-free survival rate during follow-up were compared between the two groups.Results Compared with group TURBT,HOLRBT group had shorter operation time,hospital stay,less intraoperative blood loss,and higher hospitalization costs(P<0.05).At 7 days after surgery,the levels of VEGF and IGF-Ⅰin the HOLRBT group were lower than those in the TURBT group(P<0.05).During follow-up,incidence of complications and recurrence rate in the HOLRBT group were 4.76%and 11.90%,which were lower than 19.61%and 33.33%in the TURBT group,and disease-free survival rate in the HOLRBT group was higher than 54.76%and 31.37%in the TURBT group(P<0.05).Conclusion Compared with TURBT,HOLRBT can improve intraoperative indexes,inhibit expressions of carcinogenic factors,reduce risk of complications and recurrence rate,and increase disease-free survival rate in treating NMIBC.