钬激光治疗非肌层浸润性膀胱肿瘤对血清肿瘤标志物的影响

Effect of Holmium Laser on Serum Tumor Markers in Patients with Nonmuscular Invasive Bladder Tumor

目的 探究经尿道膀胱肿瘤钬激光整块切除术(holmium laser whole block enucleation of bladder tumors,HOL-ERBT)治疗非肌层浸润性膀胱肿瘤(non muscle-invasive bladder cancer,NMIBC)对患者血清肿瘤标志物的影响。方法 回顾性分析2020年8月至2022年1月,NMIBC患者146例的临床资料,依据不同治疗方式,分为研究组和对照组,研究组患者73例,采用HOL-ERBT治疗,能量1~2 J,频率15-20 Hz,灌注0.9%氯化钠溶液,膀胱内灌注量保持为150~200 mL;对照组患者73例,采用传统经尿道膀胱肿瘤电切术(transurethral resection of bladder tumors,TURBT),电切功率160 W、电凝功率80 W。比较两组围术期相关指标及并发症发生情况。并于术前、术后7 d抽取患者血液检测氧化应激因子包括丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px);肿瘤标志物包括血管内皮生长因子(vascular endothelial growth factor,VEGF)、胰岛素样生长因子1(insulin-like growth factor-1,IGF1)、胰岛素样生长因子结合蛋白3(insulin-like growth factor-binding protein-3,IGFBP3)水平。术后随访1年,观察预后情况。结果 研究组各项围术期指标数值均明显优于对照组,同时研究组并发症发生率均明显低于对照组(P<0.05)。术后7 d,两组MDA均明显升高,但治疗组较对照组偏低(P<0.01);两组SOD、GSH-Px均明显降低,但治疗组较对照组偏高(P<0.01)。两组IGFBP3均明显升高,且治疗组较对照组更高(P<0.01);两组VEGF、IGF1均明显降低,且治疗组较对照组更低(P<0.01)。随访1年,两组复发率、总生存率比较,差异无统计学意义(P>0.05)。结论 相较于TURBT,HOL-ERBT应用于NMIBC的治疗具有围术期并发症少、疗效确切的优点,同时能够稳定氧化应激指标,降低肿瘤标志物水平,值得临床进一步研究并推广。

Objective To investigate the effect of transurethral resection of holmium laser whole block enucleation of bladder tumors(HOLERBT)on serum tumor markers in patients with non muscle-invasive bladder cancer(NMIBC).Methods Totally 146 patients with NMIBC treated from Aug.2020 to Jan.2022 were divided into two groups by treating methods,namely,the study group(HOL-ERBT,n=73)and control group(traditional transurethral resection of bladder tumor,TURBT,n=73).The perioperative indexes and complications of the two groups were compared,and the levels of chemical stress factors[malondialdehyde(MDA),superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)]and tumor markers[vascular endothelial growth factor(VEGF),insulin-like growth factor-1(IGF1)and insulin-like growth factor-binding protein-3(IGFBP3)]were measured respectively before and 7 days after the operation,and the prognosis of 1 year follow-up was recorded.Results The perioperative indexes in the study group were much better than those in the control group,and the incidence of complications in the study group significantly smaller than that in the control group.The differences between the groups were significant(P<0.05).MDA increased significantly 7 days after the operation in both groups,but the MDA of the treatment group was lower than that of the control group(P<0.01).SOD and GSH-Px dropped sharply in both groups,but the values were higher in the treatment group than in the control group(P<0.01).IGFBP3 increased remarkably in both groups,but the growth was greater in the treatment group than in the control group(P<0.01).VEGF and IGF1 decreased significantly in both groups,and the decrease was greater in the treatment group than in the control group(P<0.01).The results of one-year follow-up indicated that there was no significant difference between the two groups in recurrence rate and total survival rate(P>0.05).Conclusions Compared with TURBT,HOL-ERBT,in the treatment of NMIBC,has the advantages of definite curative effect and less complications and in the perioperative period.At the same time,it will stabilize the oxidative stress index and reduce the level of tumor markers,which makes it worthy of further research and promotion.