荧光膀胱镜下2μm激光治疗非肌层浸润性膀胱癌的临床研究  

Clinical analysis on of fluorescence cystoscopic 2-micron laser in treating non-muscle invasive bladder cancer

作　　者：宋大龙[1,2] 杨通印 胡建新[1] 刘军[1] 王元林[1] 徐述雄[1] 单刚[1] 王振兴[1] 孙兆林[1,2] SONG Dalong1,2 ,FANG Tongyin3 , HU Jianxin1 ,LIU Jun1 ,WANG Yuanlin1 , XU Shuxiong1 , SHAN Gang1,WANG Zhenxing1 ,SUN Zhaolinz1,2(1. Department of Urological Surgery, Guizhou Provincial People＇s Hospital, Guiyang , Guizhou 550002, China ; 2. Guizhou University, Guiyang, Guizhou 550025, China ; 3. Department of Pathology, Guizhou Provincial People＇s Hospital, Guiyang , Guizhou 550002, Chin)

机构地区：[1]贵州省人民医院泌尿外科,贵阳550002 [2]贵州大学,贵阳550025 [3]贵州省人民医院病理科,贵阳550002

出　　处：《重庆医学》2018年第24期3158-3161,共4页Chongqing medicine

基　　金：贵州省卫生厅科学技术基金资助项目(gzwkj2009-1-059)

摘　　要：目的探讨经荧光膀胱镜2μm激光治疗非肌层浸润性膀胱癌的临床疗效。方法 112例非肌层浸润性膀胱癌患者分为观察组(荧光膀胱镜)和对照组(白光膀胱镜)各56例。观察组56例非肌层浸润性膀胱癌患者在5-氨基乙酰丙酸(5-ALA)诱导下行荧光膀胱镜检查,用2μm激光对于肿瘤区域进行切除,对红色可疑癌变区域在活检后予以切除。对照组56例非肌层浸润性膀胱癌患者行经尿道膀胱肿瘤电切术(TURBT)治疗。观察两组患者手术时间,术中出血量,闭孔神经反射,膀胱穿孔,尿管留置时间,肿瘤检出率,病理分期和分级,术后不同时期肿瘤的复发等指标。随访观察至术后60个月。结果观察组13例患者术中在肿瘤周边区域出现红色可疑癌变区域,9例患者术后病理为低度恶性潜能尿路上皮乳头状瘤(PUNLMP),2例患者术后病理为原位癌。对照组在肿瘤周边区域发现3例PUNLMP,未发现原位癌。观察组肿瘤检出率与对照组相比高14.2%。观察组患者闭孔神经反射、膀胱穿孔情况明显优于对照组(P<0.05)。观察组患者随访至术后24个月时膀胱肿瘤复发与对照组比较差异有统计学意义(P<0.05)。结论经荧光膀胱镜2μm激光治疗非肌层浸润性膀胱癌的临床疗效较好。Objective To investigate the clinical efficacy of fluorescence cystoscopic 2-micron laser in the treatment of non-muscle invasive bladder cancer（NMIBC）.Methods One hundred and twelve patients with NMIBC were divided into the observation group（fluorescence cystoscopy）and control group（white light cystoscopy）,56 cases in each group.Fifty-six cases of NMIBC in the observation group conducted fluorescence cystoscopic examination under 5-aminolevulinic acid（5-ALA）induction.2-micron laser was used to remove the tumor area,and the red suspected cancer area was resected after biopsy.Fifty-six cases of NMIBC in the control group conducted transurethral resection of bladder tumor（TURBT）.The operative time,intraoperative hemorrhage amount,obturator nerve reflection,bladder perforation,indwelling time of urethral catheter,tumor detection rate,pathological stage and grade,tumor recurrence at different postoperative periods were observed in the two groups.The follow up and observation lasted until postoperative 60 months.Results In the observation group,reddened suspicious cancerous area surrounding tumor was intraoperatively found in 13 cases,9 cases were proved to be PUNLMP by postoperative pathology,and 2 cases were Tis.In the control group,3 cases of PUNLMP were found in the peripheral area of the tumor,and no Tis was found.The tumor detection rate of the observation group was higher than that in the control group by 14.2%.The obturator reflection and bladder perforation in the observation group was significantly superior to that in the control group（P〈0.05）.The tumor recurrence rate at 24 months after surgery had statistical difference between the observation group and control group（P〈0.05）.Conclusion The fluorescence cystoscopic 2-micron laser has good clinical effect in treating NMIBC.

关 键 词：膀胱肿瘤 荧光膀胱镜 2ΜM激光 非肌层浸润性膀胱癌 

分 类 号：R737.14[医药卫生—肿瘤]