吡柔比星膀胱黏膜下注射配合等离子针状电极行经尿道膀胱肿瘤整块切除术的临床研究

Clinical study on transurethral resection of bladder tumors by submucosal injection of pirarubicin combined with plasma needle electrode

目的探究吡柔比星膀胱黏膜下注射配合等离子针状电极行经尿道等离子膀胱肿瘤整块切除术的可行性及临床疗效。方法选取2019年5月至2021年9月华润武钢总医院泌尿外科收治的37例膀胱肿瘤患者,应用等离子针状电极配合吡柔比星膀胱黏膜下注射,行经尿道膀胱肿瘤整块除术。观察比较膀胱肿瘤标本切除的完整性、术中发生膀胱闭孔神经反射的频次及幅度、术后肿瘤复发等指标。结果37例膀胱肿瘤患者共切除肿瘤65枚,每例患者分别有1~3枚瘤体,肿瘤直径0.5~3.1 cm,均有蒂,行吡柔比星膀胱黏膜下注射配合等离子针状电极经尿道膀胱肿瘤整块切除术。其中低度恶性潜能尿路上皮乳头状瘤3例,低级别乳头状瘤27例,高级别乳头状瘤7例。膀胱侧壁肿瘤16枚,术中发生4次闭孔神经反射,未发生膀胱穿孔等并发症。术后均随诊6~24个月,无一例出现肿瘤原位复发,有3例患者膀胱肿瘤异位再发。结论应用吡柔比星膀胱黏膜下注射配合等离子针状电极行经尿道等离子膀胱肿瘤切除术符合肿瘤根治性切除原则,其疗效确切,安全可行,值得推广。

Objective To study the feasibility and clinical efficacy of pirarubicin submucosal injection combined with needle-like electrode in the removal of bladder tumors by transurethral plasma.Methods A total of 37 patients with bladder tumor admitted to our hospital from May 2019 to September 2021 were selected for transurethral resection of bladder tumor by plasma needle electrode combined with submucosal injection of pirarubicin.The completeness of bladder tumor resection,the frequency and amplitude of obturator reflex during operation,and the clinical efficacy of local tumor recurrence after operation were observed.Results Thirty-seven cases of bladder tumors,a total of 65 tumors,all underwent whole resection.Tumor size was in the range of 0.5 cm to 3.1 cm,and all had pedicles.Pathological tumor grades were 3 cases of low-grade potential urothelial papilloma,27 cases of low-grade papilloma,and 7 cases of high-grade papilloma.In 16 cases,the tumor was located in the posterior wall of the bladder.Obturator nerve reflex occurred 4 times during the operations,but no bladder perforation or other complications occurred.During the follow-up period of 6-24 months,there was no tumor recurrence in situ,but 3 cases was found ectopic recurrence of bladder tumor.Conclusions Submucosal injection of pirarubicin combined with needle-like electrode and transurethral plasma resection of bladder tumor is effective,safe and feasible.