经尿道针状电极电切术与经尿道钬激光剜除术治疗非肌层浸润性膀胱癌的前瞻性对照研究

Prospective controlled study of transurethral needle electrode resection versus transurethral holmium laser enucleation for non-muscle invasive bladder cancer

目的探讨经尿道针状电极电切术与经尿道钬激光剜除术治疗非肌层浸润性膀胱癌(NMIBC)的疗效和安全性。方法前瞻性分析2018年1月至2019年11月于十堰市人民医院泌尿外科收治的符合纳入和排除标准的膀胱癌患者95例,其中48例接受经尿道针状电极电切术,47例接受经尿道钬激光剜除术。比较针状电极电切组与钬激光剜除组围手术期情况、术后并发症、肝细胞生长因子(HGF)、肿瘤特异性生长因子(TSGF)、肿瘤坏死因子-α(TNF-α)及生存率的差异性。结果钬激光剜除组的手术时间、术中出血量、术后肉眼血尿时间、膀胱冲洗时间、术后住院时间均低于针状电极电切组(P<0.05),导尿管留置时间比较差异无统计学意义(P>0.05)。钬激光剜除组闭孔神经反射发生1例,无膀胱穿孔,尿道狭窄2例,针状电极电切组闭孔神经反射发生7例,膀胱穿孔6例,尿道狭窄3例,两组比较,剜除组的闭孔神经反射发生率和膀胱穿孔发生率均低于电切组(P<0.05),尿道狭窄的发生率差异无统计学意义(P>0.05)。术前两组HGF、TSGF和TNF-α比较差异无统计学意义(P>0.05),术后钬激光剜除组HGF、TSGF和TNF-α水平均低于针状电极电切组(P<0.05)。两组术后1年、2年、3年的无病生存率和无进展生存率比较差异均无统计学意义(P>0.05)。结论经尿道针状电极电切术与钬激光剜除术均可有效治疗NMIBC,但钬激光剜除术具有并发症较少、术后恢复较快等优势,疗效可靠,手术更安全。

【Objective】To investigate the efficacy and safety of transurethral needle electrode resection and transurethral holmium laser enucleation in the treatment of non-muscle invasive bladder cancer(NMIBC).【Methods】Ninety-five patients with bladder cancer who met the inclusion and exclusion criteria and were admitted to the Department of Urology,Shiyan People's Hospital from January 2018 to November 2019 were prospectively analyzed,of whom 48 underwent transurethral needle electrode resection and 47 underwent transurethral holmium laser enucleation.The differences in perioperative conditions,postoperative complications,hepatocyte growth factor(HGF),tumour-specific growth factor(TSGF),tumour necrosis factor-α(TNF-α)and survival rate were compared between the needle electrode resection group and the holmium laser enucleation group.【Results】The operation time,intraoperative blood loss,postoperative gross hematuria time,bladder irrigation time and postoperative hospital stay in the holmium laser enucleation group were lower than those in the needle electrode resection group(P<0.05),and there was no significant difference in catheter indwelling time between the two groups(P>0.05).In the holmium laser enucleation group,there was 1 case of obturator nerve reflex,no bladder perforation,2 cases of urethral stricture;in needle electrode resection group,there were 7 cases of obturator nerve reflex,6 cases of bladder perforation and 3 cases of urethral stricture.When compared the two groups,the incidence of obturator nerve reflex and bladder perforation in the enucleation group were lower than those in the resection group(P<0.05),and there was no significant difference in the incidence of urethral stricture between the two groups(P>0.05).There was no significant difference in HGF,TSGF and TNF-αbetween the two groups before operation(P>0.05).The values of HGF,TSGF and TNF-αin the holmium laser enucleation group were significantly lower than those in the needle electrode resection group after the operation(P<0.05).The differences in the disease-free survival rate and progression-free survival rate at 1 year,2 years and 3 years after operation between the two groups were not statistically significant(P>0.05).【Conclusion】Both transurethral needle electrode resection and holmium laser enucleation can effectively treat NMIBC,but holmium laser enucleation has the advantages of fewer complications and faster postoperative recovery,with reliable efficacy and safer operation.