經尿道鈥激光解剖性剜除術治療表淺性膀胱腫瘤的臨床療效

張金剛　周健　馬國忠

[摘要] 目的 總結并探討經尿道鈥激光解剖性剜除術治療表淺性膀胱腫瘤（non muscle invasive bladder cancer，NMIBC）的臨床療效及安全性。 方法 回顧性分析我院2016年1月以來33例表淺性膀胱腫瘤患者，均選擇行經尿道鈥激光解剖性剜除術。治療前膀胱鏡活檢病理均診斷為膀胱移行細胞癌。術后規律給予膀胱灌注1年，定期復查。 結果 33例患者均手術順利，術中無嚴重出血、閉孔神經反射、膀胱穿孔等并發癥。術后隨訪平均16個月，3例腫瘤異位復發，未見原位復發，另1例出現腫瘤浸潤進展及腦部轉移。 結論 經尿道鈥激光剜除術治療表淺性膀胱腫瘤，操作簡單，手術效果較好，解剖清晰，損傷小，復發率低，是一種安全有效的方法。

[關鍵詞] 膀胱腫瘤；表淺性；鈥激光；解剖性

[中圖分類號] R737.14 [文獻標識碼] B [文章編號] 1673-9701（2018）19-0051-03

Clinical efficacy of transurethral holmium laser anatomical enucleation in the treatment of non muscle invasive bladder cancer

ZHANG Jingang ZHOU Jian MA Guozhong

Department of Urology， Heze Mudan People's Hospital， Heze 274015， China

[Abstract] Objective To summarize and explore the clinical efficacy and safety of transurethral holmium laser anatomical debridement for the treatment of non muscle invasive bladder cancer. Methods 33 patients with superficial bladder cancer since January 2016 in this hospital were retrospectively analyzed. The patients were treated with transurethral holmium laser anatomical enucleation. The cystoscopic biopsy pathology before treatment was diagnosed as bladder transitional cell carcinoma. Postoperatively， the bladder perfusion was performed for 1 year regularly and the patients were reviewed regularly. Results 33 patients were operated smoothly.No serious complications such as severe hemorrhage， obturator nerve reflex， and bladder perforation occurred during the surgery. After an average of 16 months of follow-up， 3 cases of tumor had ectopic recurrence， and no original recurrence was observed. Another case had tumor infiltration progression and brain metastasis. Conclusion Transurethral holmium laser anatomical enucleation is safe and effective in the treatment of non muscle invasive bladder cancer with simple operation， good surgical results， clear anatomy， less damage， and low recurrence rate.

[Key words] Bladder neoplasms； Superficial； Holmium laser； Anatomy

膀胱癌是泌尿系統最常見的惡性腫瘤之一，在我國60歲以上人群中，膀胱癌發病率位于泌尿系統惡性腫瘤的第一位，且呈現逐年增長的趨勢[1]。近年來膀胱癌就診患者之中，初次診斷時75%～85%為非肌層浸潤性膀胱癌[2]。經尿道膀胱腫瘤電切術（transurethral resection of bladder tumor，TURBT）是NMIBC的首選治療方案[3]，但對于膀胱腫瘤電切過程中，閉孔神經反射和電切綜合征等并發癥也是困擾膀胱腫瘤微創治療的難題。近年來，隨著泌尿微創技術的開展，鈥激光越來越多應用于泌尿腔內手術，將鈥激光置入膀胱，可進行膀胱腫瘤剜除術。本組選擇我院2016年1月～2018年1月表淺性膀胱腫瘤（非肌層浸潤性膀胱腫瘤或NMIBC）33例，均利用電切鏡與鈥激光結合解剖性剜除膀胱腫瘤，效果可靠，現報道如下?！?br>