经尿道激光膀胱肿瘤整块切除术72例  

Transurethral Laser en Bloc Resection of Bladder Tumor: Report of 72 Cases

作　　者：张旭辉[1] 王东文[1] 杨森[1] 张彬[1] 胡操阳[1] 

机构地区：[1]山西医科大学第一医院泌尿外科,太原030001

出　　处：《中国微创外科杂志》2016年第4期326-328,332,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：国家临床重点专科建设项目(卫办医政函[2012]649号)

摘　　要：目的探讨经尿道激光膀胱肿瘤整块切除（en bloc resection）的安全性和有效性。方法 2013年6月～2015年6月,对72例膀胱肿瘤确诊患者采用经尿道激光膀胱肿瘤整块切除。根据影像学检查,术前临床分期为Ta、T1、T2N0M0,并于术前行膀胱镜检查明确肿瘤部位、数量及大小等。采用钬激光或微拉激光在距离肿瘤基底1.0 cm处对肿瘤进行整块切除,切至膀胱深肌层或浆膜层。吡柔比星或表柔比星膀胱灌注治疗1年。结果手术均顺利完成。手术时间5～30 min,平均20 min,术中基本无出血,膀胱穿孔1例,未发生闭孔神经反射。留置导尿管1～3天,47例膀胱冲洗1天。病理为尿路上皮细胞癌,术后病理分期Ta 27例,T139例,T26例。完成随访63例,随访率87.5%,随访时间2～30个月,平均13个月,复发率11.1%（7/63）。结论经尿道激光膀胱肿瘤整块切除术能快速、有效地对膀胱肿瘤进行整块切除,并能提供充足病理标本,是膀胱肿瘤腔内治疗的理想方法。Objective To evaluate the safety and efficacy of transurethral laser en bloc resection of bladder tumor.Methods A total of 72 patients with bladder tumor received transurethral laser en bloc resection of bladder tumor between June 2013 and June 2015. Preoperative cystoscopy was performed to confirm the location,numbers and size of the tumors. According to the medical imaging examinations,the preoperative clinical stages were Ta,T1,and T2N0M0,respectively. By using holmium laser or vela XL,the en bloc resection was completed near 1. 0 cm of the tumor bases until the deep muscularis or the serosal layer. The intravesical instillation of pirarubicin or epidaunorubicin was performed postoperatively. Results All the operations were technically successful,without perforation or obturator nerve reflex. The operative time was 5- 30 min（ mean,20 min）. No significant blood loss occurred during operation. The postoperative catheterization time was 1- 3 d. Bladder irrigation was carried out in 47 cases for 1 day. The pathological diagnosis was urethelial cell carcinoma. Postoperative pathological stages of enrolled cases were distributed as 27 cases of Ta staging,39 cases of T1 staging,and 6 cases of T2 staging. A total of 63 cases were followed up for 2- 30 months（ mean,13months）. The recurrence rate was 11. 1%（ 7 /63）. Conclusions Transurethral laser en bloc resection of bladder tumor is safe and effective. It can provide sufficient specimens for pathological evaluation,being an excellent intravesical therapy for bladder tumor.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤切除术 整块切除 

分 类 号：R737.14[医药卫生—肿瘤]