半导体蓝激光应用于膀胱肿瘤日间手术22例的初步体会  

Application of semiconductor blue laser in day surgery for 22 cases of bladder cancer

作　　者：郑鹏毅[1] 郭嘉[1] 每晓鹏[2] 蒋玉梅[1] 范晋海[1] 李磊[1] 王强[2] 贺大林[1] 吴开杰[1] ZHENG Pengyi;GUO Jia;MEI Xiaopeng;JIANG Yumei;FAN Jinhai;LI Lei;WANG Qiang;HE Dalin;WU Kaijie(Department of Urology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Anesthesiology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院泌尿外科,陕西西安710061 [2]西安交通大学第一附属医院麻醉科,陕西西安710061

出　　处：《现代泌尿外科杂志》2023年第2期119-121,共3页Journal of Modern Urology

基　　金：国家重点研发计划项目(No.2019YFC0121501、2019YFC0121504);陕西省重点研发项目(No.S2017-ZDYF-ZDCXL-SF-0047)。

摘　　要：目的 探讨半导体蓝激光手术系统在日间手术模式下治疗非肌层浸润性膀胱肿瘤的可行性及安全性。方法 回顾性分析西安交通大学第一附属医院2022年6月—2022年9月22例经过门诊筛查并自愿接受蓝激光日间手术的膀胱肿瘤患者的临床资料,平均年龄55.8岁,肿瘤大小平均1.4 cm。患者入院当天即安排手术,采用蓝激光整块剜除技术切除膀胱肿瘤,术后当天或者第2天晨即停止膀胱冲洗并拔除导尿管后出院。记录患者的基线资料、院前等待时间、手术时间、住院时间、血红蛋白下降量、并发症发生及处理情况、随访、医疗费用、患者满意率。结果 等待住院时间2~7 d,平均(4.1±1.3)d;手术时间29~50 min,平均(40.8±5.5)min;住院时间0.6~1.2 d,平均(0.9±0.2)d;血红蛋白下降量(g/L)1~8 g/L,平均(3.8±1.8)g/L;留置尿管时间0.5~1 d,平均(0.7±0.1) d;人均费用最少13 790~16 811元,平均(14 941.5±690.2)元;满意度为100.0%。术中、术后发生并发症2例,均为轻度不良事件,其中1例患者发生膀胱炎,给予口服头孢克肟2 d后症状消失;1例出现膀胱痉挛,给予口服琥珀酸索利那新片后缓解;术中未发生闭孔神经反射或膀胱穿孔等不良事件;拔除尿管后,未发生尿潴留事件。结论 本研究首次尝试了蓝激光日间手术用于膀胱肿瘤的治疗,证实了在合适的患者选择及成熟的技术条件下,蓝激光日间手术是一种治疗膀胱肿瘤安全、可行、经济、高效的模式,可以在有条件的医院推广。Objective To investigate the feasibility and safety of semiconductor blue laser in the treatment of non-muscle invasive bladder cancer(NMIBC) in the day surgery model.Methods The clinical data of 22 NMIBC patients(average age 55.8 years and tumor size 1.4 cm) who underwent outpatient screening and accepted blue laser ambulatory surgery in our hospital during Jun.2022 and Sep.2022 were retrospectively analyzed.On the day of admission, transurethral resection of cancer was performed using blue laser en bloc enucleation.On the day of surgery or in the morning of next day, bladder irrigation was stopped, the catheter was removed, and patients were discharged.The baseline data, pre-hospital waiting time, operation time, length of hospital stay, hemoglobin decrease, complications and management, follow-up, medical costs, and patients’ satisfaction rate were recorded.Results The pre-hospital waiting time was 2 to 7 days, average(4.1±1.3)days.The operation time was 29 to 50 minutes, average(40.8±5.5)minutes.The length of hospital stay was 0.6 to 1.2 days, average(0.9±0.2)days.Hemoglobin decrease was 1 g/L to 8 g/L,average(3.8±1.8)g/L.The catheter was indwelt for 0.5 to 1 day, average(0.7±0.1)day.The medical costs were 13 790 to 16 811 Yuan, average(14 941.5±690.2) Yuan.Patients’ satisfaction rate was 100.0%.Mild intraoperative and postoperative complications occurred in 2 cases.One patient developed symptoms of cystitis which disappeared after 2 days of oral antibiotic cefixime, and another patient developed bladder spasm which was relieved after oral solifenacin succinate tablets.No adverse events such as obturator nerve reflex or bladder perforation occurred.After removal of the catheter, no urinary retention was observed.Conclusion This study was the first to apply blue laser ambulatory surgery in the treatment of bladder cancer, confirming that it is a safe, feasible, economical and efficient model for selected patients, which can be promoted in suitable hospitals.

关 键 词：膀胱肿瘤 蓝激光 日间手术 经尿道肿瘤切除手术 

分 类 号：R737.14[医药卫生—肿瘤]