En bloc术与TURBT术治疗非肌层浸润性膀胱肿瘤临床疗效的对比研究  

Comparative study of En bloc and TURBT in the treatment of non-muscle invasive bladder tumors

作　　者：曾锋[1] 海波 曾令浩[1] 白海涛[1] 许朝晖 刘俊 袁耀美 ZENG Feng;HAI Bo;ZENG Linghao;BAI Haitao;XU Zhaohui;LIU Jun;YUAN Yaomei(Dept.of Urology,Macheng People's Hospital,Macheng 438300,Hubei,China;Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,Hubei,China)

机构地区：[1]麻城市人民医院泌尿外科,湖北麻城438300 [2]华中科技大学同济医学院附属协和医院,湖北武汉430030

出　　处：《武汉大学学报（医学版）》2022年第1期143-148,共6页Medical Journal of Wuhan University

摘　　要：目的:对比经尿道钬激光切除术(En bloc)与经尿道膀胱肿瘤电切术(TURBT)治疗非肌层浸润性膀胱肿瘤的临床疗效差异。方法:设计回顾性对照研究,选取麻城市人民医院泌尿外科2013年1月到2016年1月期间收治的非肌层浸润性膀胱肿瘤患者187例,根据患者手术方式将予以TURBT术治疗的患者标记为对照组(n=82),将予以En bloc术治疗的患者标记为观察组(n=105)。回顾分析两组患者手术时间、术中膀胱冲洗例数等围术期指标差异,比较闭孔神经反射、膀胱穿孔等术中不良事件的发生率以及术后复发率差异,采用Kaplan-Meier生存曲线分析两组患者术后生存周期差异。结果:观察组患者术后导尿管留置时间、术后膀胱冲洗总时间及住院时间均明显短于对照组(P<0.001);观察组Clavien系统Ⅲ级(0.95%vs 4.88%)、Ⅳa级(0 vs 4.88%)并发症发生率及并发症总发生率(7.62%vs 24.39%)明显低于对照组(χ^(2)=3.925,5.234,10.172,均P<0.05)。两组患者术后1年内复发率比较差异无统计学意义(P>0.05),观察组患者术后2年、术后3年复发率均明显小于对照组(P<0.05)。Kaplan-Meier分析提示,观察组患者术后3年总生存期(OS)高于对照组,低度恶性潜能的乳头状尿路上皮肿瘤(PUNLMP)及低分级尿路上皮细胞癌(LGC)患者肿瘤特异性生存率(CSS)明显高于高分级尿路上皮细胞癌(HGC)患者,Log-rank检验提示比较差异有统计学意义(P<0.05)。结论:与TURBT术相比,En bloc术治疗非肌层浸润性膀胱肿瘤的临床疗效更显著,可有效缩短患者恢复时间,降低术后复发率和不良事件发生率,提升总生存率,值得在临床推广应用。Objective:To compare the clinical efficacy of transurethral holmium laser ablation(En bloc)and transurethral resection of bladder tumor(TURBT)in the treatment of non-muscle invasive bladder tumors.Methods:A retrospective controlled study was designed in which 187 patients with non-muscle invasive bladder tumors were enrolled between January 2013 and January 2016 from Department of Urology,Macheng People′s Hospital of Hubei Province,China.Patients treated with TURBT were labeled as controls according to their surgical procedures(n=82)while the patients who were treated with En bloc were labeled as observation group(n=105).The differences of perioperative indexes such as operation time and number of intraoperative bladder irrigation were compared between the two groups.The incidence of complications such as in obturator nerve reflex and bladder perforation was also compared.The recurrence rate was analyzed by Kaplan-Meier survival curve.Results:The postoperative catheter indwelling time,the total postoperative bladder irrigation time and the hospital stay in observation group were significantly shorter than those in control group(P<0.001).The complication rate of Clavie system gradeⅢ(0.95%vs 4.88%)and gradeⅣa(0 vs 4.88%)and the total complication rate(7.62%vs 24.39%)in the observation group were significantly lower than those in the control group,with statistical significance(χ^(2)=3.925,5.234,and 10.172,respectively;P<0.05 for all).There was no significant difference in 1-year recurrence rate between the two groups(P>0.05).The recurrence rate of the observation group was significantly lower than that of the control group at the end of 2 years and 3 years after operation(P<0.05).Kaplan-Meier analysis showed that the overall survival(OS)of the observation group was higher than that of the control group 3 years after operation,and the cancer-specific survival(CSS)of PUNLMP and LGC patients was significantly higher than that of HGC patients.Log-rank test indicated that the difference was statistically significa

关 键 词：膀胱肿瘤 钬激光 经尿道膀胱肿瘤切除术 

分 类 号：R737.14[医药卫生—肿瘤]