双波长激光同期治疗高龄非肌层浸润性膀胱癌合并良性前列腺梗阻的疗效与安全分析  

Efficacy and safety analysis of simultaneous treatment of elderly non-muscle-invasive bladder cancer with benign prostatic obstruction using dual-wavelength laser

作　　者：杜新建 刘圳 陈波 唐亮 贺勇凯 黄志伟 DU Xinjian;LIU Zhe;CHEN Bo;TANG Liang;HE Yongkai;Huang Zhiwei(Department of Urology,Zhuzhou People's Hospital,Zhuzhou,Hunan 412000,China)

机构地区：[1]湖南省株洲市人民医院泌尿外科,湖南株洲412000

出　　处：《中国医学工程》2023年第9期105-109,共5页China Medical Engineering

摘　　要：目的探讨应用双波长激光同期治疗高龄非肌层浸润性膀胱癌(NMIBC)合并良性前列腺梗阻(BPO)患者的疗效与安全。方法回顾性分析2018年3月至2022年6月湖南省株洲市人民医院泌尿外科收治的13例NMIBC合并BPO的高龄患者,其中10例患者由于前列腺中叶和/或两侧叶增生并明显向膀光内突出导致不能完全显露膀胱肿瘤,为完整切除膀胱肿瘤,选择同期行双波长激光(龙激光)治疗NMIBC合并前列腺增生,达到完整切除膀胱肿瘤,同时又能完全解除前列腺增生梗阻;另3例为前列腺增生梗阻患者,B超检查发现合并膀胱单个1 cm左右大小新生物且CT检查有强化,予以诊断性激光新生物整块切除,并同期行前列腺激光分叶汽化剜,术后病检确诊NMIBC,均常规行吡柔比星膀胱灌注化疗,比较术前与术后3个月国际前列腺症状国际前列腺症状评分(IPSS)、生活质量(QOL)评分、最大尿流率Q_([max])及膀胱残余尿量,同时统计手术时间及术后并发症发生和肿瘤复发的情况。结果该组13例手术中,13例顺利完成了同期双波长激光治疗NMIBC合并前列腺增生手术,手术时间为58~94 min,平均(72.5±14.2)min。无膀胱穿孔、闭孔神经反射、尿道电切综合征及尿失禁等并发症发生。术后3个月:IPSS评分由(23.9±1.5)分降至术后(5.5±1.6)分;QOL评分由(4.3±0.6)分降至术后(1.2±0.6)分;最大尿流率Q_([max])(7.4±3.3)mL/s至术后(20.5±1.5)mL/s;膀胱残余尿量由(132.2±32.3)mL降至术后(7.7±2.9)mL,与术前比较差异有统计学意义(P<0.05)。术后两年内3例膀胱肿瘤非原位复发,均未发生在前列腺窝内,再次激光切除。结论双波长激光同期手术治疗NMIBC合并良性前列腺增生梗阻,出血少,并发症少,手术安全,下尿路症状(LUTS)改善明显,还具有术后恢复快,术后膀胱肿瘤复发率低的优势,但远期疗效有待近一步证实。【Objective】To explore the efficacy and safety of using dual-wavelength laser therapy for simultaneous treatment of elderly non-muscle-invasive bladder cancer(NMIBC)with benign prostatic obstruction(BPO)in patients.【Methods】A retrospective analysis was conducted on 13 elderly patients with NMIBC and benign prostatic obstruction who were treated between March 2018 and June 2022.Among them,ten patients had significant prostatic hyperplasia in the middle and/or lateral lobes,which caused inadequate exposure of bladder tumors for complete resection.For these cases,we chose to perform simultaneous dual-wavelength laser therapy(1470 nm/980 nm dual-wavelength laser,DwLRBT)to treat both NMIBC and prostatic hyperplasia,achieving complete bladder tumor resection while relieving the obstruction.The other three patients had prostatic obstruction,and during B-ultrasound examination,a bladder neoplasm of approximately 1 cm in size with enhancement on CT scan was detected.They underwent diagnostic laser resection of the neoplasm and simultaneous prostate laser vaporization,and postoperative pathology confirmed NMIBC.All patients received routine intravesical instillation of pirarubicin for chemotherapy.Preoperative and postoperative 3-month International Prostate Symptom Score(IPSS),Quality of Life(QOL)score,the maximum urine flow rate Q_([max])and residual bladder urine volume were compared.Surgical duration,postoperative complications,and tumor recurrence were also recorded.【Results】Among the 13 cases in this group,all patients successfully underwent simultaneous dual-wavelength laser therapy for NMIBC with benign prostatic hyperplasia,with a surgical duration ranging from 58 to 94 minutes(mean 72.5±14.2 minutes).No bladder perforation,bladder neck contracture,urethral syndrome,or urinary incontinence occurred.At 3 months postoperatively,the IPSS score decreased from 23.9±1.5 to 5.5±1.6,the QOL score decreased from 4.3±0.6 to 1.2±0.6,the Q_([max])score decreased from 7.4±3.3 mL/s to 20.5±1.5 mL/s,and the res

关 键 词：非浸润性膀胱癌 良性前列腺梗阻 双波长激光 前列腺汽化剜除术 

分 类 号：R737.14[医药卫生—肿瘤]