肿瘤基底黏膜下吉西他滨溶液扩张辅助1470 nm激光经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌  

One thousand four hundred and seventy nm laser en bloc transurethral resection of bladder tumor combined with tumor submucosal injection of Gemcitabine for the treatment of non-muscle invasive bladder cancer

作　　者：杨成林 王尉 肖远松 聂海波 周五二 张小明 王葵 YANG Chenglin;WANG Wei;XIAO Yuansong;NIE Haibo;ZHOU Wuer;ZHANG Xiaoming;WANG Kui(Department of Urology,General Hospital of Southern Theatre Command of China People′s Liberation Army,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院泌尿外科,广州510010

出　　处：《实用医学杂志》2019年第1期61-65,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金面上项目(编号:81372744)

摘　　要：目的探讨肿瘤基底黏膜下吉西他滨溶液扩张辅助1 470 nm激光经尿道肿瘤整块切除术治疗非肌层浸润性膀胱癌(NMIBC)的疗效及安全性。方法回顾性分析中国人民解放军南部战区总医院2014年8月至2016年2月收治的62例确诊为NMIBC患者的临床资料,其中行肿瘤基底黏膜下吉西他滨溶液扩张辅助1 470 nm激光经尿道肿瘤整块切除术(观察组)30例,行经尿道膀胱肿瘤切除术(对照组)32例,两组术后维持膀胱灌注化疗方案相同。比较两组患者术前、术中和术后的临床及随访资料。结果两组手术时间、术中膀胱穿孔发生率相比较,差异无统计学意义(P> 0. 05);观察组与对照组术中闭孔神经反射发生率[0 vs. 18.8%(6/32)]、术后膀胱冲洗时间[(0.81±0.41)d vs.(1.85±0.75)d]、术后留置尿管时间[(3.93±0.91)d vs.(5.16±0.90)d]、住院时间[(5.13±0.94)d vs.(6.19±0.90)d]相比较,观察组均优于对照组,差异具有统计学意义(P <0.05)。0.5、1、1.5年无肿瘤复发生存率观察组分别为:96.7%、93.3%、90.0%,对照组分别为:87.5%、75.0%、68.8%(log-rankχ2=4.118,P=0.042);0.5、1、1.5年无肿瘤复发进展生存率观察组分别为:96.7%、96.7%、93.3%,对照组分别为:93.8%、84.4%、81.3%(log-rankχ2=1.954,P=0.162);两组治疗6个月后的躯体功能、心理功能、社会功能、物质生活四个维度的评分均差异无统计学意义(P> 0.05)。结论肿瘤基底黏膜下吉西他滨溶液扩张辅助1 470 nm激光经尿道肿瘤整块切除术治疗NMIBC,安全有效,值得在临床推广应用。Objective To evaluate the efficacy and safety of 1 470 nm laser en bloc transurethral resection of bladder tumor combined with tumor submucosal injection of Gemcitabine in the treatment of non-muscle invasive bladder cancer.Methods The clinical data of 62 cases with NMIBC treated with endoscopic surgery during August 2014 and February 2016 were analyzed retrospectively.These data including preoperative,operative,and postoperative management and follow-up were recorded.Results There were no difference in operative duration and bladder perforation between the two groups(P﹥0.05).The observation group was superior than the control group in terms of obturator nerve reflex[0 vs.18.8%(6/32)],postoperative bladder irrigation time[(0.81±0.41)d vs.(1.85±0.75)d],urethral catheterization[(3.93±0.91)d vs.(5.16±0.90)d]and hospitalization[(5.13±0.94)d vs.(6.19±0.90)d].The 0.5 year,1 year and 1.5 year tumor free rates in the observation group were 96.7%,93.3%and 90.0%,while in the control group were 87.5%,75.0%and 68.8%(log-rankχ^2=4.118,P=0.042).The 0.5 year,1 year and 1.5 year tumor free progression rates in the observation group were 96.7%,96.7%and 93.3%,while in the control group were 93.8%,84.4%and 81.3%(log-rankχ^2=1.954,P=0.162).The body function,psychological function,social function and material life of four dimensions scores have no obvious difference between these two groups(P﹥0.05).Conclusions One thousand four hundred and seventy nm laser en bloc transurethral resection of bladder tumor combined with tumor submucosal injection of gemcitabine is an effective and safety method in treating NMIBC.Therefore,it is worthy of popularization.

关 键 词：非肌层浸润性膀胱癌 1470nm激光 吉西他滨 整块切除 

分 类 号：R737.14[医药卫生—肿瘤]