肿瘤基底黏膜下水扩张辅助激光切除治疗单发非肌层浸润性膀胱癌的初步研究  

Submucosa dilation assisted laser resection of bladder tumor for the treatment of solitary non-muscle invasive bladder cancer： initial experience

作　　者：张振声[1] 许传亮[1] 孙颖浩[1] 杨波[1] 王洋 沈诞[1] 吴承耀[1] 徐伟东[1] 曾钦松[1] 唐亮[1] 

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433 [2]病理科

出　　处：《中华泌尿外科杂志》2011年第11期771-774,共4页Chinese Journal of Urology

摘　　要：目的探讨采用肿瘤基底黏膜下水扩张辅助激光切除治疗单发非肌层浸润性膀胱癌的疗效。方法全身麻醉或连续硬膜外麻醉下，采用Cook膀胱黏膜注射针在肿瘤基底周围2cm处黏膜下注射无菌灌注用水，黏膜呈丘状隆起、肿瘤与肌层脱离后，采用钬激光或铥激光沿隆起边缘切除膀胱肿瘤，共治疗12例，常规行肿瘤基底活检，术后常规行膀胱灌注化疗。结果肿瘤直径0．5～2．3cm。12例均为膀胱尿路上皮肿瘤，术后病理报告低度恶性倾向尿路上皮乳头状瘤3例，低分级乳头状尿路上皮癌9例；临床分期T19例，T13例。12例手术均成功，手术时间20～45min．平均25min；术中出血〈5ml。12例均未输血，未发生闭孔神经反射及膀胱穿孔、尿外渗，无电切综合征。基底组织活检阴性。术后持续冲洗1d；留置尿管1～4d，平均3d；术后住院3～6d，平均5d。随访4～36个月，未见肿瘤复发。结论肿瘤基底黏膜下水扩张辅助钬激光切除非肌层浸润性膀胱癌有效、安全，术中、术后并发症少，术后复发率低。Objective To evaluate the safety and efficacy of submucosa dilation assisted laser re- section of bladder tumor for the treatment of solitary non-muscle invasive bladder cancer. Methods A total of 12 patients with solitary non-muscle invasive bladder tumor were treated with the procedure of submucosa dilation assisted laser resection under total intravenous anesthesia or epidural anesthesia, lntravesical instillation chemotherapy was performed according to CUA 2007 guidelines. Patients were followed up for 4 - 36 months after the operation. Results The diameter range of the tumors was O. 5 - 2.3 cm with the clinical stage T - T1 and low pathology grade. Submucosa dilation assisted laser resection of bladder tumor was successfully performed on all patients. The average operation time was 25 min （range, 20 -45 rain） , and the catheter time was 3 d （range, 1 -4 d）. The mean volume of bleeding was less than 5 ml, no patient required blood transfusion. No complications such as obturator nerve reflex, bladder perforation and over-hydration occurred. No recurrence occurred during the follow-up. Conclusions Submueosa dilation assisted laser resection of bladder tumor could be an effective, safe, and excellent alternative procedure for the treatment of solitary non-muscle invasive bladder cancer, with few complications and a low recurrence rate. More studies and long-term follow-ul3 should be warranted to ultimately evaluate this orocedure.

关 键 词：膀胱肿瘤 激光手术 切除 黏膜下 扩张术 

分 类 号：R737.14[医药卫生—肿瘤]