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HoL-EBRBT与TURBT治疗非肌层浸润性膀胱肿瘤疗效比较
作者:何路耿  何华东  李莉  陈超  王旭亮  胡逸轩 
单位:浙江大学医学院附属杭州市第一人民医院泌尿外科  浙江 杭州 310006 
关键词:膀胱肿瘤/外科学 激光疗法 钬/治疗应用 尿道/外科学 电外科手术 手术后并发症 治疗结果 随机对照试验 
DOI:10.13267/j.cnki.syzlzz.2018.06.011
出版年,卷(期):页码:2018,33(6):548-552
摘要:

目的 比较经尿道膀胱肿瘤钬激光整体切除术(holmium laser en bloc transurethral resection of bladder tumor,HoL-EBRBT)与经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)在非肌层浸润性膀胱肿瘤中的疗效和安全性。方法 收集95例非肌层浸润性膀胱肿瘤患者用抽签法随机分成两组。其中HoL-EBRBT组49例行HoL-EBRBT治疗,TURBT组46例行TURBT治疗。比较两组术前、术中及术后随访资料。结果 HoL-EBRBT组和TURBT组在手术时间和术后住院时间方面比较,差异均无统计学意义(均P>0.05)。HoL-EBRBT组无患者发生闭孔神经反射和膀胱穿孔,低于TURBT组的13例和12例(均P<0.01)。HoL-EBRBT组的组织膀胱肌层获取率为95.9%,高于TURBT组的67.4%(P<0.01)。HoL-EBRBT组新发的膀胱肿瘤患者术后1年肿瘤复发率低于TURBT组新发的膀胱肿瘤患者(P<0.05)。复发性膀胱肿瘤总的1年肿瘤复发率高于初发性膀胱肿瘤(P<0.01)。肿瘤切除术后1年复发率在吸烟史或肿瘤多灶性方面比较,差异均无统计学意义(均P>0.05)。结论 HoL-EBRBT治疗非肌层浸润性膀胱肿瘤安全有效,尤其对于新发的膀胱肿瘤。

Objective To compare the safety and efficacy of holmium laser en bloc transurethral resection of bladder tumor (HoL-EBRBT) and transurethral resection of bladder tumor(TURBT) in the treatment of nonmuscle-invasive bladder cancer. Methods Ninety-five cases of nonmuscle-invasive bladder cancer patients were enrolled and randomly assigned into two groups by the drawing lots.Among them,49 patients underwent HoL-EBRBT and 46 patients underwent TURBT.The clinical data,including preoperative,operative,and postoperative management and follow-up,were recorded and compared between the two groups. Results There were no significant differences in the operative duration and postoperative hospitalization time between the two groups (Both P>0.05).Nevertheless,in the TURBT group,13 cases developed obturator nerve reflex,and 12 cases showed bladder perforation.In comparison,no occurrence of either symptoms was observed in the HoL-EBRBT group (both P<0.01).Moreover,the detrusor muscle could be identified pathologically in 95.9% of HoL-EBRBT tumor specimens,but only in 67.4% of TURBT samples (P<0.01).Furthermore,the 1-year recurrence rate was significantly lower in the patients of HoL-EBRBT group with primary bladder cancer than that in the TURBT group (P<0.05).Besides,in both groups,the 1-year recurrence rate of all the recurrent bladder cancer patients was higher than that of primary bladder cancer(P<0.01).Finally,no impact was detected of smoking history or tumor multiplicity on 1-year recurrence rate (both P>0.05). Conclusion HoL-EBRBT is a safe and effective treatment for non-muscle-invasive bladder tumors,especially for primary bladder cancer.

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