2μm连续式激光治疗初发非肌层浸润性膀胱肿瘤的前瞻性随机对照研究  

Prospective randomized controlled study on treatment for primary non-muscle-invasive bladder tumor with 2-μm continuous wave laser

作　　者：鲁文龙[1] 冯超[1] 朱卫东[1] 郭辉[1] 谷宝军[1] 司捷旻[1] 张心如[1] 

机构地区：[1]上海交通大学附属第六人民医院泌尿外科,上海200233

出　　处：《临床泌尿外科杂志》2015年第2期107-111,共5页Journal of Clinical Urology

摘　　要：目的：通过与经尿道膀胱肿瘤切除术（TURBT）比较,探讨2μm连续式激光治疗初发非肌层浸润性膀胱肿瘤（NMIBC）的可行性。方法：通过前瞻性随机化分组方法,将2006年1月~2010年12月收治入院的400例初发膀胱肿瘤患者分为TURBT组及2μm连续式激光治疗组（TULVBT组）,TURBT组行标准TURBT,TULVBT组采用2μm连续式激光汽化处理膀胱肿瘤后,以环形附件清理肿瘤基底部焦痂,随后改以膀胱镜行基底部活检。对疑有首次腔内手术肿瘤残余或术后病理缺少膀胱肌层者,于术后3~4周行重复TURBT（reTURBT）。所有患者每3个月随访膀胱镜至术后2年,随后改为每6个月1次。结果：共292例患者纳入本项研究,其中TURBT组143例,TULVBT组149例,两组肿瘤相关资料的差异无统计学意义（P〉0.05）。TURBT组手术时间（28.43±13.19）min,TULVBT组（31.51±12.80）min（P=0.044）。TURBT组中6例因闭孔反射致膀胱穿孔,其中1例中止手术,TULVBT组未出现严重术中并发症。44例接受re-TURBT,TURBT组17例（11.9%）,TULVBT组27例（18.1%）（P=0.137）,其中因切除物病理无肿瘤下膀胱肌层27例,TURBT组9例（6.3%）,TULVBT组18例（12.1%）（P=0.088）。129例36个月内出现肿瘤复发,TURBT组61例（42.7%）,TULVBT组68例（45.6%）（P=0.608）。平均无肿瘤复发生存时间TURBT组为（25.46±13.18）个月,TULVBT组（24.88±12.85）个月（P=0.729）。19例肿瘤进展,TURBT组11例（7.7%）,TULVBT组8例（5.4%）（P=0.421）。结论：2μm连续式激光可作为治疗初发NMIBC的手段,辅以常规膀胱镜下活检即可获得较完整的肿瘤病理资料,可获得与TURBT相似的治疗效果。Objective：To evaluate the effectiveness and feasibility of treating primary non-muscle-invasive bladder cancer（NMIBC）with 2-μm continuous-wave（CW）thulium laser compared with transurethral resection of bladder tumor（TURBT）.Method：From January 2006 to December 2010,we enrolled and randomly assigned 400 consecutive patients newly diagnosed with clinical stage Taor T1 bladder cancer in our hospital into TURBT or laser vaporesection（TULVBT）treatment groups.Patients in TURBT group accepted standard transurethral resection with bipolar electrocautery system and patients in TULVBT group accepted transurethral vaporesection with2-μm CW thulium laser.In TULVBT group,patients needed to accept an additional cystoscopic biopsy on bladder muscle for separate histopathology after tumors vaporesected by 2-μm CW thulium laser and superficial cauterized tissue of the base was swept off.Re-TURBT was needed to perform 3-4weeks after initial endoscopic operation for those with suspected tumor residue or absence of muscle information in histopathology after initial procedure.Cystoscopy was performed every three months in the first two years,and then once every six months.Result：Totally 292 patients were included in our analysis,143 to receive TURBT and 149 to receive TULVBT.TURBT was significantly superior to TULVBT in terms of operation time（28.43±13.19 vs 31.51±12.80 minutes,P =0.044）.Among 44patients（17in TURBT and 27 in TULVBT,P =0.137）who had to accept Re-TURBT,27 patients were found absence of detrusor muscle,9（6.3%）in TURBT group and 18（12.1%）in TULVBT group（P =0.088）.During 36-month follow-up period,129cases（44.2%）was detected tumor recurrence,61（42.7%）in TURBT and 68cases（45.6%）in TULVBT（P =0.608）,and 19patients（6.5%）were found tumor progression,11 in TURBT（7.7%）and 8（5.4%）in TULVBT（P =0.421）.Average tumor free survival time was 25.16±12.99months（25.46±13.18 in TURBT vs 24.88±12.85 in TULVBT,P =0.729）.Conclusion：The procedure of 2-μm CW t

关 键 词：非肌层浸润性膀胱肿瘤 经尿道膀胱肿瘤切除术 激光 无肿瘤复发生存时间 

分 类 号：R737.14[医药卫生—肿瘤]