不同膀胱癌切除术的临床效果比较

Comparison of clinical efficacy of different bladder cancer resection

目的比较双极和单极经尿道外侧壁膀胱癌切除术(TURBT)在闭孔神经阻滞(ONB)下治疗侧壁非肌层浸润性膀胱癌(NMIBC)的围手术期结果和并发症。方法选取我院收治的外侧壁原发膀胱癌患者200例,依据双盲法分为观察组和对照组,每组100例。观察组予以双极TUR(B-TURBT)治疗,对照组予以单极TUR(M-TURBT)治疗。对比两组围手术期结果(包括闭孔神经反射、肌肉组织取样和热组织损伤、血红蛋白减少、钠减少、手术时间、住院时间及导管插入时间)和术后并发症(切口感染、肠梗阻、心肺脑意外、吻合口狭窄、肾积水和活动性血尿)。结果治疗后两组患者的闭孔神经反射、肌肉组织取样率和热组织损伤率比较,P>0.05;两组血红蛋白减少、钠减少、手术时间、住院时间比较,P>0.05;观察组导管插入时间明显低于对照组(P<0.05)。观察组术后并发症发生率显著低于对照组(P<0.05)。结论在外侧壁原发膀胱癌患者的治疗中,M-TURBT和B-TURBT均可通过脊髓麻醉联合ONB安全有效地实施。但是,M-TURBT患者术后导管插入时间长,术后并发症发生率高,因此,在外侧壁原发膀胱癌患者的治疗中更推荐B-TURBT。

Objective To compare the perioperative outcomes and complications of bipolar and unipolar transurethral lateral wall bladder cancer resection(TURBT)under obturator nerve block(ONB)in the treatment of lateral wall nonmuscular-infiltrating bladder cancer(NMIBC).Methods A total of 200 patients with NMIBC were selected and divided into the observation group(100 cases)and the control group(100 cases)according to double-blind method.The observation group was treated with bipolar TUR(B-TURBT),while the control group was treated with unipolar TUR(M-TURBT).The perioperative results(including obturator nerve reflex,muscle sampling rate and the thermal damage rate,decreased hemoglobin and sodium,operation time,hospitalization time and catheterization time)and postoperative complications(incision infection,intestinal obstruction,heart,lung and brain accident,anastomotic stricture,hydronephrosis and active hematuria).Results There was no significant difference in obturator nerve reflex,muscle tissue sampling rate and thermal tissue injury rate between the two groups(P>0.05).There was no significant difference in hemoglobin reduction,sodium reduction,operation time and hospitalization time between the two groups(P>0.05).The time of catheter insertion in the observation group was significantly shorter than that in the control group(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion In the treatment of patients with NMIBC,both M-TURBT and B-TURBT can be safely and effectively.However,M-TURBT patients have a long postoperative catheterization time and a high incidence of postoperative complications.Therefore,B-TURBT is more recommended in the treatment of patients with NMIBC.