【摘要】 目的探讨经尿道钬激光切除非肌层浸润性膀胱尿路上皮癌的疗效和安全性。方法 2010年4月～2011年3月,将60例非肌层浸润性膀胱尿路上皮癌,按随机化原则,通过计算机抽样随机分为2组,钬激光切除组30例,经尿道等离子电切(bipolar transurethral resection in saline,TURis)组30例,比较2组患者围手术期情况,包括术中出血量、闭孔反射发生率、术后冲洗量、导尿管保留时间、术后住院时间及术后3个月复查情况。结果钬激光组术中无闭孔神经反射发生,TURis组术中闭孔神经发射发生率36.7%(11/30),2组有显著性差异(Fisher’s检验,P=0.000)。钬激光组手术时间(26.7±14.1)min,明显短于对照组手术时间(42.3±13.8)min(t=4.331,P=0.000)。钬激光组术后冲洗量中位数9000 ml(0～30 000 ml)明显少于对照组术后冲洗量中位数18 000 ml(0～50 000 ml)(Z=-2.810,P=0.005)。2组尿隐血量、导尿管保留时间、术后住院时间和术后3个月复发率无统计学差异(P>0.05)。结论与TURis切除非肌层浸润性膀胱尿路上皮癌相比,经尿道钬激光切除具有止血更确切、出血更少、无闭孔神经反射的优点,是安全且疗效可靠的手术方式。更多还原

【Abstract】 Objective To compare the efficacy and safety of transurethral holmium laser resection with bipolar transurethral resection in saline(TURis) for non-muscle invasive bladder cancer.Methods During the period of April 2010 to March 2011,60 cases of non-muscle invasive bladder cancer were randomly divided into two groups: holmium laser group(30 cases) and TURis group(30 cases).The peri-operative indicators including intraoperative blood loss,incidence rate of obturator reflex,postoperative flushing volume,catheter retention time,postoperative hospital stay,and postoperative recurrence rate in 3 months were compared between the two groups.Results The holmium laser groups showed significantly lower rate of obturator reflex,shorter operation time,and less flushing volume [0 vs.36.7%(11/30),Fisher’s test,P=0.000;(26.7±14.1) min vs.(42.3±13.8) min,t=4.331,P=0.000;and 9000 ml(0-30 000 ml) vs.18 000 ml(0-50 000 ml),Z=-2.810,P=0.005;respectively].No significant difference existed in the urine occult blood quantity,catheter retention time,postoperative hospital stay,and 3-month postoperative recurrence rate(P>0.05).Conclusions Transurethral holmium laser is superior to TURis for resection of non-muscle invasive bladder cancer,for it is more accurate and effective in bleeding control and zero obturator reflex.It is a safe and effective therapy.更多还原