经尿道钬激光切除术和电切术对浅表性膀胱癌患者疗效及预后的影响

Efficacy of transurethral holmium laser resection of bladder tumor and electroresection and their effects on the prognosis of patients with superficial bladder cancer

目的分析经尿道钬激光切除术(holium laser resection of bladder tumor,HOLBT)和经尿道电切术(transurethral resection of bladder tumor,TURBT)对浅表性膀胱癌患者围手术期指标、炎性因子及预后的影响。方法选取2018年7月至2021年1月行手术治疗的浅表性膀胱癌患者101例,按照手术方案不同分为TURBT组48例和HOLBT组53例。比较两组围手术期指标、治疗前后肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)、白介素-10(interleukin-10,IL-10)、血管内皮生长因子(vascular endothelial growth factor,VEGF)及成纤维细胞生长因子(fibroblast growth factor,FGF)水平的差异,并观察两组术后并发症的发生及复发率情况。结果两组手术时长比较,差异无统计学意义(P>0.05);HOLBT组术中失血量低于TURBT组,留置尿管时间短于TURBT组(P<0.05)。两组治疗后TNF-α、IL-6及IL-10水平均较治疗前上升,HOLBT组治疗后IL-10水平高于TURBT组,但TNF-α、IL-6水平均低于TURBT组(P<0.05)。两组治疗后VEGF、FGF水平均显著下降,HOLBT组VEGF、FGF水平均低于TURBT组(P<0.05)。HOLBT组并发症总发生率低于TURBT组,差异具有统计学意义(P<0.05)。两组术后3个月复发率比较,差异无统计学意义(P>0.05);HOLBT组术后6个月、12个月复发率低于TURBT组(P<0.05)。结论HOLBT与TURBT相比较,前者治疗浅表性膀胱癌患者围手术期指标更优,可更显著改善炎性因子水平,且预后良好,为临床治疗方案提供一定参考。

Objective To analyze the effects of holmium laser resection of bladder tumor(HOLBT)and transurethral resection of bladder tumor(TURBT)treatment on the perioperative indexes,inflammatory factors and prognosis.Methods Totally,101 patients with superficial bladder cancer who were treated in our hospital from July 2018 to January 2021 were selected.The patient were divided into TURBT group(48 cases)and HOLBT group(53 cases)according to the different surgical protocols.We compared perioperative indexes and levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-10(IL-10),vascular endothelial growth factor(VEGF),and fibroblast growth factor(FGF)between the two groups,and analyzed postoperative complications and recurrence.Results There was no significant difference in the operation time between the two groups(P>0.05).The HOLBT group had less intraoperative blood loss and shorter period of indwelling catheter compared to the TURBT group(P<0.05).The levels of TNF-α,IL-6 and IL-10 in both groups were increased after treatment.Compared to TURBT group,the level of IL-10 was higher and the levels of TNF-α and IL-6 were lower in HOLBT group(P<0.05).After treatment,VEGF and FGF levels in both groups were significantly decreased,and their levels were lower in HOLBT group than those in TURBT group(P<0.05).The overall complication rate in HOLBT group was lower than that in TURBT group(P<0.05).There was no significant difference in the recurrence rate between the two groups at 3 months after surgery(P>0.05);the recurrence rates of HOLBT group at 6 and 12 months after surgery were lower than those of TURBT group(P<0.05).Conclusion Compared with TURBT,HOLBT has better perioperative indicators in the treatment of patients with superficial bladder cancer,can significantly improve the levels of inflammatory factors,and has a good prognosis,which provides certain reference values for clinical treatment.