多技术融合手术在非肌层浸润性膀胱癌治疗中的临床效果分析  

Clinical effect of multi-technique fusion surgery in the treatment of non-muscle invasive bladder cancer

作　　者：马曜辉 单中杰[1] 郭亮[1] 张楠[1] MA Yaohui;SHAN Zhongjie;GUO Liang;ZHANG Nan(Department of Urology, People's Hospital of Zhengzhou, Zhengzhou 450000, China)

机构地区：[1]郑州人民医院泌尿外科,450000

出　　处：《现代泌尿生殖肿瘤杂志》2021年第6期330-335,共6页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的比较多技术融合的手术方案与经尿道膀胱肿瘤切除术(TURBT)治疗非肌层浸润性膀胱癌(NMIBC)的效果差异。方法收集2016年5月至2018年5月在郑州人民医院治疗NMIBC的142例患者,根据手术方式的不同分为融合组89例和TURBT组53例。融合组采用基于窄带光成像技术(NBI)+肿瘤基底组织分离法+2μm铥激光+肿瘤完整剥离术的多技术融合手术方案,TURBT组采用TURBT术;术后两组均规律行吉西他滨(1 g吉西他滨+40 ml 0.9%生理盐水)膀胱灌注化疗9个月,并定期复查随访。对比两组患者的手术时间、术中出血量、膀胱冲洗时间、术后住院时间、手术并发症率、尿管留置时间以及病理检查肌层发现率、可疑组织病理阳性检出率、复发率及无进展生存期。结果融合组手术时间高于TURBT组(P<0.05),而术中出血量、膀胱冲洗时间、尿管留置时间、术后住院时间、闭孔神经反射发生率及手术总并发症率显著低于TURBT组(P<0.05);融合组的肌层发现率、可疑组织活检阳性率均显著高于TURBT组(P<0.05);融合组1年、2年及随访截止时的肿瘤复发率均显著低于TURBT组(P<0.05),中位无进展生存期均显著高于TURBT组(P<0.05)。结论多技术融合手术方案治疗NMIBC较常规TURBT并发症风险低、恢复时间短、无进展生存期更长,值得临床推广使用。Objective To investigate the clinical effect of multi-technique fusion surgery program and trasurethral resection of bladder tumor(TURBT)in the treatment of non-muscle invasive bladder cancer(NMIBC).Methods From May 2016 to May 2018,142 NMIBC patients who treated in Zhengzhou People's Hospital were collected and divided into the fusion group(n=89)and TURBT group(n=53)according to the surgical method.The fusion group was treated with multi-technique fusion surgery program based on narrow-band light imaging(NBI)+tumor basal tissue separation+2μm thulium laser+complete tumor dissection method,and TURBT group were treat with transurethral resection of bladder tumor.Both the two groups received gemcitabine bladder perfusion chemotherapy(1 g gemcitabine+40 ml 0.9%normal saline)regularly after operation for 9 months,and were followed up regularly.The operative time,intraoperative blood loss,bladder irrigation time,postoperative hospitalization time,operative complication rate,catheter indwelling time,the detection rate of muscular layer on pathological examination,the positive rate of pathological examination of suspicious tissue,recurrence rate and progression-free survival were compared between the two groups.Results The operative time in the fusion group was significantly higher than that in TURBT group(P<0.05),but the intraoperative blood loss,bladder irrigation time,catheter indwelling time,postoperative hospitalization stay,the rate of obturator nerve reflex and total surgical complications were significantly lower than those in TURBT group(P<0.05).The detection rate of muscular layer and the positive rate of suspicious tissue biopsy in fusion group were significantly higher than those in TURBT group(P<0.05),and the tumor recurrence rate in 1,2 years or at the end of follow-up in the fusion group were significantly lower than those in TURBT group(P<0.05).The median(progression-free survival of fusion group 35 months)was significantly higher than that in TURBT group(32 months,P<0.05).Conclusions Compared with TURB

关 键 词：非肌层浸润性膀胱癌 多技术融合 经尿道膀胱肿瘤电切术 复发 

分 类 号：R73[医药卫生—肿瘤]