应用钬激光治疗膀胱肿瘤34例报告

Holmium laser resection of bladder tumors: 34 cases report

目的 探讨钬激光治疗膀胱肿瘤的临床效果。方法 采用OmniPulse MAXTMModel12 10 VHP 10 0W钬激光 ,膀胱镜下以脉冲能量 1 0～1 5J、频率 15～ 4 0Hz、功率 15～4 0W治疗 34例经病理确诊的膀胱移行细胞癌患者。其中男性 30例 ,女性 4例 ,所有肿瘤均为T1～T2a期 ,GⅠ～GⅡ级。结果 2 6例患者单用钬激光顺利去除肿瘤 ,7例加用电刀切除 (TURBT) ,1例因出血量多影响视野 ,加之肿瘤位于膀胱顶部 ,放弃钬激光治疗 ,改为手术治疗。操作时间 5～ 6 0min,平均 2 0min。术中无严重出血、膀胱穿孔及闭孔神经反射。仅 1例患者术后有轻度继发性出血。30例获随访 ,随诊时间 3～12个月 ,3例膀胱肿瘤异位复发 ,无原位复发。结论 膀胱镜下用钬激光治疗膀胱肿瘤操作简单、副反应少、安全有效 ,但操作过程中需连续冲水 ,否则视野模糊影响操作。

Objective To evaluate the clinical experience in the treatment of the bladder cancer with holmium laser. Methods From June 2001 to June 2002, a total of 34 cases of transitional cell bladder carcinoma, including 30 male and 4 female, with clinical stage T 1 to T 2a and grade I to Ⅱ, were treated with holmium laser. A 550um end firing fiber was delivered through 21 Fr cystoscopy and power(1 to 1.5 J) was delivered at 15 to 40 pulses per second. Results Bladder tumors were resected easily in 26 cases with holmium laser. In 7 cases it was supplemented with TURBT. Only in one case, holmium laser treatment was given up because of continuous bleeding. The patient was then treated with partial cystectomy. Laser operating time ranged form 5min to 60min, mean 20min. Side effects such as uncontrollable bleeding, perforation of bladder, and obturator nerve reflection were not found. 30 cases were followed up for 3 to 12 months, and tumor recurrence were found in 3 cases. Conclusion Holmium laser resection of bladder tumors is a safe, effective, simple method with less side effects. But the field of vision will be obscure unless continuous irrigation is given during operation.