经尿道等离子针状电极加凝固电极膀胱肿瘤逐层整块切除术的临床研究

Transurethral plasma needle electrode plus coagulation electrode excision of bladder tumor layer by layer

目的:探讨经尿道等离子针状电极加凝固电极膀胱肿瘤逐层整块切除术治疗膀胱癌的安全性及治疗效果。方法:回顾性分析2016年6月～2017年12月我院收治的45例膀胱癌患者的临床资料。男37例,女8例;年龄30～80岁,平均(58±13)岁,中位年龄69.5岁;肿瘤直径1～3 cm,平均(2.2±1.4)cm,中位直径1.9 cm;肿瘤单发36例,多发9例(2枚6例,3枚3例);位于膀胱侧壁19例,后壁16例,其他部位10例。术前活检病理诊断均为膀胱尿路上皮癌。术前CTU检查提示均无膀胱壁外浸润,上尿路均无肿瘤。45例均在硬腰麻醉下行经尿道等离子针状电极加凝固电极膀胱肿瘤逐层整块切除术,术中采用针状电极行经尿道膀胱肿瘤逐层整块切除,再用凝固电极凝固创面,标本送病理。结果:45例手术均顺利完成,切除肿瘤57枚,肿瘤大小0.5～3.0 cm;手术时间15～53 min,平均(30±19) min;术中出血量1～10 ml,平均(5±3) ml,1例发生闭孔神经反射(ONR),其余均无ONR,无穿孔及术后出血等并发症;所有患者均用吉西他滨50 mg即刻或术后24 h内膀胱灌注化疗,无明显不良反应。术后病理诊断均为非肌层浸润性膀胱癌(NMIBC),切缘均为阴性。病理分期分级:T_1G_1尿路上皮癌52枚,T_1G_2尿路上皮癌3枚,T_1G_3尿路上皮癌2枚。术后3个月复查膀胱镜创面愈合良好。45例随访6～24个月,平均(6.1±5.3)个月,均无肿瘤复发。结论:经尿道等离子针状电极加凝固电极膀胱肿瘤逐层整块切除术治疗NMIBC具有解剖清晰、有效降低ONR、出血少、无穿孔、标本完整、可获得精确病理分期、恢复快、临床应用效果满意等优点。

Objective:To evaluate the safety and efficacy of transurethral plasma needle electrode combined with coagulation electrode for bladder tumor resection.Method:The clinical data of 45 patients with bladder cancer admitted in our hospital from June 2016 to December 2017 were retrospectively analyzed.There were 37 males and 8 females.They were 30-80 years old,with an average age of(58±13)years old.The diameter of tumor ranged from 1 to 3 cm,with an average of(2.2±1.4)cm.There were 36 cases of solitary tumor and 9 cases of multiple tumors,of which 2 lumps were found in 6 cases and 3 lumps were found in 3 cases.There were 19 cases of lateral wall of bladder,16 cases of posterior wall,and 10 cases of other parts.Preoperative pathological diagnosis was bladder urothelial carcinoma.Preoperative CTU showed no infiltration outside the bladder wall,and no tumor was found in the upper urinary tract.Transurethral plasma needle electrode plus coagulation electrode for bladder tumor resection under epidural spinal anesthesia was performed in 45 cases.During the operation,transurethral resection of bladder tumor was performed with needle electrode(hook electrode).Coagulating electrode was used to coagulate the wound.Specimens were sent to pathology.Result:Forty-five cases were successfully performed.Fifty-seven tumors were removed and the size of tumors ranged from 0.5 to 3 cm.The operation time ranged from 15 to 53 min,with an average of(30±19)min,and the intraoperative blood loss ranged from 1 to 10 ml,with an average of(5±3)ml.Obturator nerve reflex occurred only in 1 case.No perforation or postoperative bleeding was found.All patients were treated with intravesical instillation of chemotherapy with gemcitabine 50 mg immediately or after 24 h without obvious adverse reactions.Postoperative pathological diagnosis was non-muscle invasive bladder cancer(NMIBC).The margins were negative.Pathological stage classification showed 52 T1G1 urothelial carcinomas,3 T1G2urothelial carcinomas,and 2 T1G3urothelial carcinomas.The cystoscope showed all the wounds healed well after 3 months.All 45 cases were followed up for 6-24 months,averaging(6.1±5.3)months.No tumor recurrence occurred.Conclusion:Transurethral plasma needle electrode plus coagulation electrode for bladder tumor resection layer by layer in the treatment of NMIBC shows advantages of clear anatomy,effective reduction of obturator nerve reflex,less bleeding,no perforation,intact specimens,accurate pathological stages,quick recovery and satisfactory clinical effects.