三种腔镜技术应用于治疗非浸润性膀胱肿瘤的疗效、安全性比较

 目的 探讨绿激光、等离子双极电气化、普通电切3种腔镜技术治疗非浸润性膀胱肿瘤的有效性、安全性。方法 对536例次非浸润性膀胱肿瘤患者进行回顾性研究分析, 绿激光组215例, 等离子组187例, 普通电切组134例, 对3组之间的手术时间、术后留置尿管时间、术后住院时间、术后复发率、并发症等进行比较。结果 3组之间的手术时间［(50.18±18.76) min vs (49.88±13.23) min vs (51.21±15.32) min］之间的差异无统计学意义。术后留置尿管时间绿激光组与其他两组相比差异具有统计学意义［(4.92±3.67) d vs (9.16±4.56) d vs (9.37±5.78) d, P＜0.05］, 后两组间差别无统计学意义。术后住院时间三组之间差异均具有统计学意义［(7.64±4.87) d vs (13.15±12.84) d vs (16.24±13.23) d, P＜0.05］, 绿激光组时间最短, 电切组时间最长。绿激光组术后复发率明显低于其他两组, 且其差异具有统计学意义(7.4% vs 15.5% vs 17.2%, P＜0.05), 后两组差异无统计学意义。膀胱痉挛(4.2% vs 9.6% vs 15.7%)、继发性出血(0% vs 7.5% vs 13.4%)等并发症的发生在绿激光组最低, 其差异具有统计学意义(P＜0.05), 而等离子组和电切组之间的差异无统计学意义(P＜0.05)。结论 绿激光治疗非浸润性膀胱肿瘤是安全、有效的, 具有创伤小、出血少、留置尿管时间短、术后住院时间短、恢复快、术后复发率低等优势, 其在手术局部不产生电场效应, 从而避免了闭孔神经反射的发生。

Comparison of three telescopes for treatment of non muscle-invasive bladder cancer

Objective To evaluate the safety and efficacy of greenlight laser selective vaporization, per urethra dipolar plasma electrotomy and transurethral electroresection for the treatment of non muscle-invasive bladder cancer. Methods 536 cases of non-invasive bladder cancer during May 2002 to December 2011 were retrospective studied. The patients were divided into 3 groups according to operative procedures: green laser group (PVP group, 215 cases), transurethral plasma bipolar electric excision group (PKRBt group, 187 cases) and transurethral electroresection group (TURBt group, 134 cases). The indexes were compared including operation time, urinary indwelling catheter time after operation, length of stay after operation, relapse rate and complications after operation. Results There were no significant differences in operation time ［(50.18±18.76) min VS (49.88±13.23) min VS (51.21±15.32) min］ and incidence of infection(3.7% VS 7.0% VS 6.0%) after operation in the 3 groups. And the time of urinary indwelling catheter in PVP group was significantly shorter than in the other 2 groups ［(4.92±3.67) d VS (9.16±4.56) d VS　(9.37±5.78)　d, P＜0.05］, and there was no significant difference between PKRBt group and TURBt group. PVP group had a shortest length of stay after operation and TURBt group had a longest length of stay ［(7.64±4.87)　d VS (13.15±12.84)　d VS (16.24±13.23) d, P＜0.05］. The relapse rate in PVP group was significantly lower than in the other groups(7.4% VS 15.5% VS 17.2%, P＜0.05) and there was no significant difference between PKRBt group and TURBt group. The complications in PVP group were significantly fewer than in the other 2 groups(P＜0.05) and there was no significant difference between PKRBt group and TURBt group. Conclusions PKRBt has no more advantages besides fewer obturator nerve reflex than TURBt. Green laser photoselective vaporization is one kind of safe and effective treatment for non muscle-invasive bladder cancer. And it have such superiority as fewer trauma and bleeding, shorter time of indwelling urinary catheter and length of stay after operation, lower relapse rate and no obturator nerve reflex.