经尿道膀胱肿瘤切除专用手术刀具的临床应用  

The clinical application of modified transurethral resection of bladder tumor with specially designed scalpel

作　　者：王东文[1] 梁学志[1] 曹晓明[1] 刘春[1] 张雁钢[1] 杨晓峰[1] 刘红耀[1] 王毅东[2] 孙元星[3] 程书栋 马志方[1] 米振国[1] 

机构地区：[1]山西医科大学第一医院泌尿外科,太原030001 [2]山西中医学院附属中西医结合医院泌尿外科 [3]大同市第五人民医院泌尿外科 [4]晋中市人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2006年第3期184-186,共3页Chinese Journal of Urology

摘　　要：目的对经尿道膀胱肿瘤切除专用手术刀具治疗浅表性膀胱肿瘤进行临床应用评价。方法在传统电切刀的远端添加保护襻组成膀胱肿瘤切除专用手术刀具。使用该种手术刀具治疗浅表性膀胱肿瘤48例，使用方法与普通电切刀近似。男26例，女22例。年龄23—76岁，平均43岁。肿瘤分期Tis者1例，T0～T1者47例。肿瘤分级G1～G2者36例，C3～G4者12例。瘤体直径0．5—8．0cm。肿瘤位于膀胱顶部4例，左侧壁11例，右侧壁9例，前壁4例，后壁13例，颈部7例。肿瘤单发31例，多发17例。术后常规卡介苗膀胱灌注1年，每3个月行膀胱镜检查1次。结果48例平均手术时间（23±10）min。术中18例（37．5％）发生闭孔神经反射，未出现膀胱穿孔病例；无瘤体后部的正常膀胱黏膜误切。46例术后随访1年，14例复发，均为远位新生膀胱肿瘤，术后3个月时发现1例，4～6个月时3例，7—9个月时6例，10—12个月时4例。结论使用该专用手术刀具治疗浅表性膀胱肿瘤容易控制切除深度，可最大限度地避免膀胱穿孔，并可保护大体积肿瘤后部盲区的正常黏膜以免误切。Objective To evaluate the clinical efficacy of a newly designed surgical knife in transurethral resection of bladder tumor （TURBt）, Methods We developed a special scalpel which was characterized by a protective loop at the distal end of conventional knife, The modified TUR-Bt with this scalpel was performed in 48 cases （26 men and 22 wmnen） of superficial bladder tumor. Their age ranged from 23 to 76 years with a mean of 43 years. All the patients underwent B-uhrasonography, CT or MRI, and cystoscopy preoperatlvely,and pathologic confirmation of tumor stage and grade postoperatively, For tumor stage,1 case had Ti, tumor,and 47 cases had T0 -T1 tumor, For tumor grade,36 cases had G1 -G2 tumor,and 12 cases had G3 - G4 tumor. The tumor diameter ranged from 0, 5 to 8, 0 cm, The tumor sites were as follows： at the top of the bladder （4 cases） ,on the left wall （ 11 ）, right wall （ 9 ）, front wall （4）, back wall （ 13 ）, at the neck （7）. Thirty-one cases had single tumor and 17 had multiple tumors, After operation all the patients received 1-year intravesical instillation of BCG,and underwent eystoscopy every 3 months. Results The mean operative time was （23 ± 10） min, Reflection of obturator nerve occurred in 18 cases （37, 5% ） during operation. No one had bladder perforation ; and no normal bladder mucosa was resected on the back of the neoplasms. Follow-up was 1 year. Two cases were lost to follow-up. Relapse occurred in 14 cases, but all were not in the initial sites. Of these, 1 case was detected at 3 months ;3 cases,at 4 - 6 months ;6 cases, at 7 - 9 months ;4 cases,at 10 - 12 months after operation, The results were similar to those of conventional TUR-Bt. Conclusions Using modified TUR-Bt with protective loop for the treatment of superficial bladder tumor, it is easier to control resection depth and to prevent bladder perforation mostly, Moreover, it can protect norreal mucosa of blind areas on the back of big neoplasms.

关 键 词：膀胱肿瘤 手术 

分 类 号：R737.14[医药卫生—肿瘤] R446.6[医药卫生—临床医学]