【作者】 李博；

【导师】 傅强；

【作者基本信息】 山东大学 ， 外科学（专业学位）， 2017， 硕士

【摘要】 [目的]比较分析经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)与经尿道膀胱黏膜剥离联合钬激光膀胱肿瘤切除术(endoscopic submucosal dissection combined holmium laser resection of bladder tumor,ESD-HOLRBT)两种手术方法在治疗非肌层浸润性膀腕肿瘤(non muscle-invasive bladder cancer,NMIBC)中临床效果的安全性和有效性以及预后情况,探讨未来非肌层浸润性膀胱肿瘤治疗的新方向。[方法]本研究采取回顾性分析的方法,严格遵循病例入选和排除标准,选取山东大学附属省立医院保健泌尿外科自2015年1月至2016年6月期间收治的非肌层浸润性膀胱肿瘤患者共94例。录入患者的基本信息及临床资料,并进行统计分析。根据患者的症状、体征、病史、术前相关辅助检查等,正确判断手术指征,合理评估手术风险,分别行TURBT和ESD-HOLRBT,以此分为TUR]BT手术组(A组,51例)和ESD-HOLRBT手术组(B组,43例)。针对两组从手术时间、膀胱冲洗时间、留置导尿管时间、住院时间;闭孔神经反射、电切综合征、膀胱穿孔、尿路感染发生率;术后3个月、6个月及12个月复发情况等反应两种手术的有效性、安全性及预后的相关指标进行对照分析。应用SPSS 20.0软件进行数据的录入、统计、分析。两组间定性数据采取卡方检验,定量数据资料以X、S表示,采取t检验,P<0.05为差异有统计学意义。[结果]所有94例患者均一次性成功完成手术。TURBT与ESD-HOLRBT两组间年龄、性别、有无肉眼血尿、肿瘤数量、肿瘤直径等一般信息均无明显统计学差异(P>0.05),具有可比性。反应手术有效性的指标方面,两组手术时间、膀胱冲洗时间、留置导尿管时间、住院时间相比有明显的差异(P<0.05)。TURBT组仅在手术时间上优于ESD-HOLRBT组,其余指标均表明ESD-HOLRBT组更胜一筹。反应手术安全性及预后的指标方面,两组发生闭孔神经反射、电切综合征、膀胱穿孔、大出血、尿路感染以及术3个月、6个月、12个月肿瘤复发率,ESD-HOLRBT较TURBT组占有明显优势。[结论]1、ESD-HOLRBT具有术中失血极少,术野清晰,不发生闭孔神经反射、膀胱穿孔及电切综合征,术后留置尿管时间短,下床活动恢复快,患者遭受痛苦小的优点。2、ESD-HOLRBT方便切除特殊部位肿瘤,切割精准,几乎无残留,病理标本完整,可精确判断分级、分期,正确指导术后治疗,极大降低了复发率。3、ESD-HOLRBT适应证广泛,操作简便、过程安全、疗效显著、复发率低。可作为治疗NMIBC的理想手术方式,值得推广。更多还原

【Abstract】 [Objectives]To compare and analyze the advantages and disadvantages,safety and efficacy of two surgical methods which are TURBT and ESD-HOLRBT in the treatment of non-myometrial invasive bladder neoplasms(NMIBC),and to explore the future of non-muscular invasive bladder cancer treatment of new directions.[Methods]94 cases who are suffering from the NMIBC were chosen as sample since January 2015 to December 2016 in Health Care Urology Surgery of affiliated Shandong Province Hospital of Shandong University.According to the patient’s symptoms,signs,history,preoperative related auxiliary examination,etc.,all patients were respectively treated by TURBT and ESD-HOLRBT,after a correctly determine the surgical indication and a reasonable assessment of surgical risk.In which 5lcases was treated by TURBT,and 43 cases was cured by ESD-HOLRBT.Retrospective analysis of the efficacy and safety indictors among the two group in the time of operation,the incidence of obturator nerve reflex,transurethral resection syndrome,postoperative bladder rinse time,catheter retention time,length of stay,the incidence of related complications,follow-up in 3,6 and 12 months tumor recurrence rate,etc.Using SPSS 20.0 software for data entry,statistics,analyze.Qualitative data between the two groups using chi-square test,quantitative data using t test,P<0.05 for the difference was statistically significant.[Results]All 94 patients completed the procedure successfully.TURBT and ESD-HOLRBT between the two groups of age,gender,with or without gross hematuria,tumor number,tumor diameter and other general information were no significant difference(P>0.05),comparable.There were significant differences in the operative time,bladder rinse time,indwelling catheterization time and hospitalization time between the two groups(P<0.05).The TURBT group was superior to the ESD-HOLRBT group at the time of surgery,and the remaining indicators indicated that the ESD-HOLRBT group was superior.Respiratory safety and prognosis of the two groups of the occurrence of obturator reflex,electrical resection syndrome,bladder perforation,bleeding,urinary tract infection and surgery 3 months,6 months,12 months tumor recurrence rate,ESD-HOLRBT has a significant advantage over TURBT.[Conclusions]1.ESD-HOLRBT with minimal intraoperative blood loss,surgical field clear,do not occur obturator nerve reflex,bladder perforation and resection syndrome,postoperative indwelling catheter short time,get out of bed to recover fast,patients suffer little pain advantage.2.ESD-HOLRBT to facilitate the removal of special parts of the tumor,accurate cutting,almost no residual,pathological specimens complete,can accurately determine the classification,staging,the correct guidance of postoperative treatment,greatly reducing the recurrence rate.3.ESD-HOLRBT extensive indications,easy operation,process safety,significant effect,low recurrence rate.Can be used as the ideal surgical treatment of NMIBC,it is worth promoting.更多还原