1470 nm激光膀胱肿瘤整块切除术在多发非肌层浸润性膀胱癌中的应用  

1470 nm Laser En Bloc Resectionin the Treatment of Primary Multiple Non-Muscle-Invasive Bladder Tumor

作　　者：张源锋[1] 陈少川[1] 蓝开健[1] 姜婧琦 吴维楚 徐庆春[1] 林伟强[1] 张永海[1] Zhang Yuanfeng;Chen Shaochuan;Lan Kaijian;Jiang Jingqi;Wu Weichu;Xu Qingchun;Lin Weiqiang;Zhang Yonghai(Department of Urology,the Shantou Central Hospital,Shantou 515031,Guangdong,China;Departmentof Urology,the Second Hospital Af filiated to Lanzhou University,Lanzhou University,Lanzhou 730000,Gansu,China)

机构地区：[1]汕头市中心医院泌尿外科,广东汕头515031 [2]兰州大学第二医院泌尿外科,甘肃兰州730000

出　　处：《应用激光》2024年第12期187-194,共8页Applied Laser

基　　金：汕头市医疗卫生科技计划(汕府科[2021]3号-11)。

摘　　要：目的:评价经尿道1470 nm激光膀胱肿瘤整块切除术(ERBT)与经尿道膀胱肿瘤电切术(TURBT)治疗多发的原发性非肌层浸润性膀胱肿瘤(NMIBC)的安全性和有效性。方法:收集汕头市中心医院泌尿外科2020年10月至2022年7月收治的57例确诊为多发的原发性NMIBC患者的临床资料,其中25例接受1470 nm激光ERBT治疗,32例接受TURBT治疗。两组术后维持膀胱灌注化疗方案相同。主要观察指标是围手术期参数、标本质量、围手术期并发症和肿瘤复发率。结果:两组患者和肿瘤基线特征具有可比性。与TURBT组相比,1470 nm激光组术后膀胱冲洗时间明显减少(0.88±0.14 vs 1.24±0.53)、闭孔神经反射发生率(4% vs 21.82%)和膀胱穿孔发生率(0 vs 15.64%)明显降低,差异有统计学意义(P<0.05)。88%的1470 nm激光组和46.87%的TURBT组病理标本中检出逼尿肌(P<0.05)。平均随访10.8(10~18)个月后,两组间的肿瘤原位复发率(8%vs 9.37%)和创面外复发率(12%vs 12.5%)比较无显著差异(P>0.05)。结论:研究结果表明,1470 nm激光ERBT术是治疗多发原发性NMBIC的可行、安全和有效的替代方法。Objectives:Toassess the safety and efficacy of 1470 nm laser en bloc resection(ERBT)compared to transurethral resection of bladder tumor(TURBT)in the treatment of primary multiple non-muscle invasive bladder cancers(NMIBC).Methods:Clinical datafrom 57 patients with multiple primary NMIBC treated at the Department of Urology,Shantou Central Hospital from October 2020 to July 2022 were analyzed.Of these,25 patients underwent 1470 nm laser en bloc resection,and 32 underwent TURBT.Both groups received identical postoperative maintenance bladder irrigation chemotherapy.Perioperative clinical characteristics,specimen quality,perioperative complications,and recurrence rates were recorded and compared.Results:There were no differences with the preoperative characteristics between the patients in the two groups.The 1470 nm laser group was superior than the TURBT group in terms of the postoperative bladder irrigation time(0.88±0.14 vs 1.24±0.53),obturator nerve reflection(4% vs 21.82%)and bladder perforation(0 vs 15.64%),with statistically significant differences(P<0.05).Detrusor was found in 88% of the 1470 nm laser group and 46.87% of the pathological specimens in the TURBT group(P<0.05).After a mean follow-up of 10.8(10-18)months,the recurrence rates outside the wound margin were 12% in laser group and 12.5% in TURBT group,and the in situ recurrence rates were 8% and 9.37% respectively.The recurrence rate did not differ significantly between two groups.Conclusions:The study indicates that 1470 nm laser en bloc resection is a viable,safe,and effective alternative treatment for primary multiple non-muscle-invasive bladder tumors.

关 键 词：膀胱肿瘤 经尿道膀胱肿瘤电切术 1470 nm激光 整块切除术 手术并发症 

分 类 号：R616.4[医药卫生—外科学]