经尿道单极和双极电切术治疗非肌层浸润性膀胱癌的临床效果比较  

Comparison of clinical effect between bipolar and monopolar transurethral resection for non-muscle invasive bladder cancer

作　　者：李仲辉 赵文兵 王毅东 邢涛 Li Zhonghui;Zhao Wenbing;Wang Yidong;Xing Tao(Department of Urology,Shanxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine,Taiyuan 030013,China)

机构地区：[1]山西省中西医结合医院泌尿外科,太原030013

出　　处：《微创泌尿外科杂志》2023年第1期42-46,共5页Journal of Minimally Invasive Urology

基　　金：山西省应用基础研究计划项目(201901D111401)。

摘　　要：目的:观察并比较经尿道膀胱肿瘤电切术(TURBT)中运用单极和双极电切对非肌层浸润性膀胱癌(NMIBC)患者疗效、并发症的影响。方法:回顾分析2016年3月至2019年7月行TURBT的100例NMIBC癌患者的病例资料,其中行双极电切术者55例,单极电切术者45例。对比两组的手术指标、术后并发症及无疾病生存期(DFS)。单因素及多因素Cox回归分析影响预后的独立危险因素。结果:两组患者术后导尿管留置时间和住院时间差异无统计学意义(P>0.05)。双极电切组相比单极电切组手术用时和出血量低,差异具有统计学意义(P<0.001)。两组患者膀胱穿孔、电切综合征、血栓滞留、输血、尿路感染和急性尿潴留发生率差异均不存在统计学意义(P>0.05)。单极电切术组相比双极电切组闭孔神经反射发生率高(35.6%vs.14.5%;P=0.014)。双极电切组的中位DFS为45个月,单极电切组的中位DFS为52个月,两组差异无统计学意义(HR=1.334;P=0.270)。Cox回归分析结果表明病理T分期可作为预后的独立危险因素(HR=1.52,95%CI:1.18~2.34;P=0.021)。结论:双极电切术和单极电切术相比一样安全有效,但双极电切术可进一步降低并发症发生率。Objective:To observe and compare the surgical indicators,complications and prognosis of patients with non-muscle invasive bladder cancer(NMIBC)treated with bipolar and monopole resection of bladder tumors.Methods:Data of 100 NMIBC patients who underwent transurethral resection of bladder tumor(TURBT)from March 2016 to July 2019 were analyzed,containing 55 patients who underwent bipolar resection of bladder tumor and 45 patients who underwent monopolar resection.Surgical indicators,postoperative complications and disease free sur⁃vival(DFS)were compared between two groups.Independent prognostic risk factors were analyzed by univariate and multivariate Cox regression analysis.Results:The operative time and blood loss in bipolar group were lower than those in monopolar group(P<0.001),and there were no significant differences in the duration of indwelling catheter and hospital stay between the two groups(P>0.05).The incidence of obturator nerve reflex in bipolar group was lower than that in monopolar group(14.5%vs.35.6%;P=0.014).No differences were found in the incidence of blad⁃der perforation,electrosurgical resection syndrome,thrombosis retention,blood transfusion,urinary tract infection and acute urinary retention between the two groups(P>0.05).The median DFS of the bipolar group was 45 months,and the median DFS of the monopolar group was 52 months(HR=1.334;P=0.270).Cox regression analy⁃sis indicated that pathological T stage was an independent risk factor for prognosis(HR=1.52,95%;CI:1.18~2.34;P=0.021).Conclusions:Bipolar resection of transurethral bladder tumors is as safe and effective as the monopolar resection,however,bipolar resection can further reduce the incidence of complications.

关 键 词：膀胱肿瘤 手术后并发症 预后 

分 类 号：R737.14[医药卫生—肿瘤]