1470 nm激光膀胱肿瘤整块切除与传统电切治疗非肌层浸润性膀胱癌的比较

A control study of the safety and efficacy of 1470 nm laser en bloc resection of bladder tumor versus transurethral resection of bladder tumor in the treatment of non-muscular invasive bladder cancer

目的比较分析1470 nm激光整块切除膀胱肿瘤术(1470 nm-EBRBT)与传统经尿道膀胱肿瘤电切术(TURBT)对非肌层浸润性膀胱癌(NMIBC)的安全性及疗效的差异。方法选取2017年1月至2020年1月行膀胱镜检查及病理诊断为NMIBC(Ta或T1期)患者100例作为研究对象,采取随机方法将患者分为观察组和对照组各50例,观察组采用1470 nm-EBRBT,对照组采用TURBT,术后均常规行吉西他滨膀胱灌注化疗以及二次电切和定期膀胱镜检查等,平均随访时间为(31±4)个月。比较两组在安全性、疗效、病理结果和无复发生存率的差异。结果观察组手术并发症发生率低于对照组,术后停留尿管时间和住院时间均短于对照组,差异均有统计学意义(P<0.05);两组的初次切除标本病理类型和级别比较,差异均无统计学意义(P>0.05),观察组在初次切除病理标本中含逼尿肌比例高于对照组,差异有统计学意义(P<0.05),观察组在二次电切病理的肿瘤残留率低于对照组,差异无统计学意义(P>0.05)。两组的无复发生存曲线和Cox回归危险比Exp(B)比较,差异均无统计学意义(P>0.05)。结论与传统TURBT相比,1470 nm-EBRBT对于NMIBC患者具有手术疗效确切,病理标本完整,肿瘤残留可能性更少,并发症更少,留置尿管时间及住院时间更短的优势。

Objective To compare and analyze the safety and efficacy of 1470 nm laser en bloc resection of bladder tumor(1470 nm-EBRBT)and traditional transurethral resection of bladder tumor(TURBT)in the treatment of non-muscular invasive bladder cancer(NMIBC).Methods A total of 100 patients with NMIBC(Ta or T1)diagnosed by cystoscopy and pathology from January 2017 to January 2020 were selected as subjects.The patients were randomly divided into observation group(n=50)and control group(n=50).The observation group was treated with 1470 nm-EBRBT and the control group with TURBT.All patients were followed up for(31±4)months with gemcitabine intravesical instillation chemotherapy,secondary electroresection and regular cystoscopy.The safety,efficacy,pathological results and recurrence-free survival rate were compared between the two groups.Results The operative complications in the observation group were less than those in the control group,the catheter indwelling time and hospitalization in the observation group were shorter than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the pathological type and grade of the first resected specimens between the two groups(P>0.05).The proportion of detrusor in the first resected pathological specimens in observation group was higher than that in control group,and the difference was statistically significant(P<0.05).The tumor residual rate in observation group was lower than that in control group,and the difference was not statistically significant(P>0.05).There was no significant difference in recurrence-free survival curve and cox regression hazard ratio Exp(B)between the two groups(P>0.05).Conclusions Compared with traditional TURBT,1470 nm-EBRBT has the advantages of accurate surgical effect,complete pathological specimens,less possibility of tumor residue,fewer complications,shorter indwelling catheter time and shorter hospitalization time for NMIBC patients.