经尿道等离子整块切除术在非肌层浸润性膀胱癌中的应用研究

Application of transurethral plasma en bloc resection in non-muscle-invasive bladder cancer

目的探讨经尿道双极等离子肿瘤整块切除术(ERBT)治疗非肌层浸润性膀胱癌(NMIBC)的临床效果。方法回顾性分析2019年1月至2021年6月本院泌尿外科治疗的79例非肌层浸润性膀胱尿路上皮癌患者的临床资料, 其中观察组行经尿道双极等离子ERBT治疗(39例), 对照组行常规经尿道膀胱肿瘤电切术(cTURBT)治疗(40例)。所有患者术后规律行盐酸吡柔比星膀胱灌注化疗, 术后3、6、12、24个月行泌尿系彩超、膀胱镜检查。观察并分析比较两组患者的手术时间、术中出血量、留置尿管时间、术中不良事件发生情况及术后复发情况。结果 79例患者均成功完成手术, 无中转开放手术, 无输血病例。两组患者的手术时间、术中出血量、留置尿管时间及闭孔发射发生率比较, 差异均无统计学意义(均P>0.05)。观察组的逼尿肌可见率高于对照组[92.3% (36/39)vs. 52.5%(21/40), P<0.05]。两组患者均无围手术期大出血、膀胱穿孔发生。观察组肿瘤复发5例(12.8%), 对照组复发14例(35.0%), 两组2年内总复发率比较, 差异有统计学意义(P<0.05);对照组的2年累计复发率高于观察组(P<0.05)。结论与cTURBT相比, ERBT是治疗NMIBC的一种安全有效的方法, 组织病理标本中的肌层可见率明显提高, 可在把握适应证的情况下在临床推广应用。

Objective To investigate the clinical effect of transurethral bipolar plasma en bloc resection of bladder tumors(ERBT)in the treatment of nonmuscle invasive bladder cancer(NMIBC).Methods The clinical data of 79 patients treated in the department of urology of our hospital from January 2019 to June 2021 for NMIBC were retrospectively analyzed,including 39 patients in the observation group who received transurethral bipolar plasma ERBT and 40 patients in the control group who received conventional transurethral resection of bladder tumor(cTURBT).Bladder infusion chemotherapy with pirubicin hydrochloride was regularly performed after surgery.Urological ultrasound and cystoscopy were reexamined 3,6,12 and 24 months after surgery.The operative time,intraoperative blood loss,catheter indwelling time,intraoperative adverse events and postoperative recurrence were observed and compared between the two groups.Results There was no significant difference in the operative time,intraoperative blood loss,catheter indignant time and incidence of obturator emission between 2 groups(all P>0.05).The visible rate of detrusor muscle in observation group was higher than that in control group[92.3%(36/39)vs.52.5%(21/40),P<0.05].No perioperative hemorrhage or bladder perforation occurred in both groups.There were 5 cases of tumor recurrence in the observation group(12.8%,5/39)and 14 cases in the control group(35.0%,14/40).The total recurrence rate within 2 years was significantly different between the two groups(P<0.05).The 2-year recurrence rate of control group was higher than that of observation group(P<0.05).Conclusions Compared with cTURBT,ERBT is a safe and effective treatment method for NMIBC,and the visibility of muscle layer in histopathological specimens is significantly improved.Therefore,ERBT can be popularized in clinical application under the condition that indications are understood.