经尿道膀胱肿瘤整块切除术治疗初发非肌层浸润性膀胱癌的安全性及疗效分析  

The safety and efficacy of transurethral en bloc resection of bladder tumor in the treatment of primary non-muscular invasive bladder cancer

作　　者：许生 吴挺明 吴淑龄 陈化磊[1] 胡鑫明[1] 徐磊[1] 古军[1] 车宪平[1] XU Sheng;WU Tingming;WU Shuling;CHEN Hualei;HU Xinming;XU Lei;GU Jun;CHE Xianping(Department of Urology, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China)

机构地区：[1]海南医学院第二附属医院泌尿外科,海南海口460106

出　　处：《中国肿瘤外科杂志》2020年第6期504-507,共4页Chinese Journal of Surgical Oncology

基　　金：海南省自然科学基金(819MS127)。

摘　　要：目的评估经尿道膀胱肿瘤整块切除术(ERBT)治疗初发非肌层浸润性膀胱癌(NMIBC)的安全性及有效性。方法回顾性分析2017年3月至2018年12月海南医学院第二附属医院收治的67例初发NMIBC患者的临床资料,其中31例行ERBT(ERBT组),36例行传统的经尿道膀胱肿瘤切除术(TURBT组)。比较两组患者的手术时间、住院时间、留置导尿管时间、标本中是否含有膀胱肌层、膀胱穿孔发生率、闭孔神经反射发生率及患者的无复发生存率。结果ERBT组的手术时间长于TURBT组[(39.8±9.8)min vs.(30.4±8.3)min];ERBT组的住院时间少于TURBT组[(3.6±1.0)d vs.(4.3±0.9)d],导尿管留置时间少于TURBT组[(2.4±0.7)d vs.(2.8±0.6)d],差异均有统计学意义(P<0.05);ERBT组标本中膀胱肌层的存在率为96.8%,显著高于TURBT组77.8%(P=0.031)。ERBT组术中闭孔神经反射的发生率为0%,显著低于TURBT组16.7%(P=0.027);ERBT组术中发生膀胱穿孔1例,TURBT组4例,差异无统计学意义(P=0.363)。ERBT组术后1年的无复发生存率为88.7%,TURBT组为82.5%,差异无统计学意义(P=0.397)。结论ERBT治疗初发NMIBC患者的住院时间及导尿管留置时间较短,闭孔神经反射发生率低,安全性较好,疗效显著,值得临床推广。Objective To evaluate the safety and efficacy of transurethral en bloc resection of bladder tumor(ERBT)in the treatment of primary non-muscular invasive bladder cancer(NMIBC).Methods The clinical data of 67 patients with primary NMIBC were analyzed retrospectively,including 31 cases of ERBT and 36 cases of TURBT.The operation time,hospital stay,indwelling catheter time,bladder muscle layer,bladder perforation,obturator nerve reflex and recurrence-free survival rate were compared between the two groups.ResultsThe operation time of ERBT group and TURBT group was(39.8±9.76)min vs.(30.4±8.25)min(P=0.001),the hospital stay was(3.6±1.0)days vs.(4.3±0.9)days(P=0.003),and the indwelling catheter time was(2.4±0.7)days vs.(2.8±0.6)days(P=0.010),respectively.The existence rate of bladder muscle layer in ERBT group was 96.8%,which was significantly higher than that in TURBT group(77.8%)(P=0.031).The incidence of intraoperative obturator nerve reflex in the ERBT group was 0%,which was significantly lower than that in the TURBT group(16.7%)(P=0.027).There was 1 case of bladder perforation in ERBT group and 4 cases in TURBT group,and there was no significant difference between the two groups(P=0.363).The 1-year recurrence-free survival rate(RFS)of the ERBT group was 88.7%,while that of the TURBT group was 82.5%,but the difference was not statistically significant(P=0.397).Conclusions ERBT has shorter hospitalization time and catheter indwelling time,lower incidence of obturator nerve reflex,better safety and remarkable curative effect in patients with newly diagnosed NMIBC,which is worthy of clinical promotion.

关 键 词：经尿道膀胱肿瘤整块切除术 非肌层浸润性膀胱癌 铥激光 安全性 有效性 

分 类 号：R73[医药卫生—肿瘤]