膀胱镜下膀胱肿瘤激光切除术与电切术的临床疗效对比研究

目的:探讨膀胱镜下膀胱肿瘤激光切除术与电切术的临床疗效及安全性。方法:选择2012年11月至2014年8月行膀胱肿瘤激光切除或电切术的163例患者,其中85例行激光切除术(激光组),电切组78例,对比分析两组手术时间、术中出血量、并发症发生率、术后导尿管留置时间、术后住院时间及随访情况。结果:163例均顺利完成手术,激光组与电切组手术时间(24.2±2.4)min vs.(29.7±2.4)min]、术后留置导尿管时间(2.83±0.96)d vs.(3.19±0.91)d]差异有统计学意义(P<0.001),激光组闭孔神经反射发生率低于电切组,术中出血量(19.5±3.7)mL vs.(26.5±2.3)mL]低于电切组。两组患者术后均随访36个月,Kaplan-Meier生存曲线显示两组无瘤生存率差异无统计学意义(P=0.406),术后3年总体复发率差异无统计学意义。结论:与传统膀胱肿瘤电切术相比,激光切除的手术时间短,并发症发生率低,可作为膀胱镜下膀胱肿瘤切除术安全、可靠的替代术式,并且激光切除术可获取完整的术后病理组织,对于判断预后及后续治疗方案的制定具有重要作用。

Comparison of the clinical efficacy of laser resection and electro-resection under cystoscopy for urinary bladder tumor

Objective:To evaluate the safety and efficacy of laser resection and electro-resection under cystoscopy for urinary bladder tumors.Methods:A total of 163 consecutive patients with urinary bladder tumor were treated by laser resection(n=85) or electro-resection(n=78) from Nov.2012 to Aug.2014.The operative time,intraoperative blood loss,complication rates,postoperative catheterization time,hospitalization time,and postoperative follow-up data were recorded and compared between the two groups.Results:Surgery was successful in all 163 patients.There were no differences in the preoperative characteristics between the patients in two groups.The mean operative time was(24.2±2.4)min for laser resection group and(29.7±2.4)min for electro-resection group(P<0.001).A significant difference in favor of laser resection group was achieved for the postoperative catheterization time (2.83±0.96)d vs.(3.19±0.91)d,P=0.036) ].The incidence of obturator nerve reflection in laser group was lower than that in electro-resection group.The intraoperative blood loss in laser group was lower than that in electro-resection group (19.5±3.7)mL vs.(26.5±2.3)mL,P=0.041)].The postoperative hospitalization time showed no significant difference in the two groups.The disease-free survival rate did not differ between two groups after 3 years’ follow-up according to Kaplan-Meier survival curves(P>0.05).There was no significant difference in the total recurrence incidence of postoperative 3 years.Conclusions:Compared with traditional electro-resection,the laser resection of bladder tumor under cystoscopy is reliable,safe,and effective alternative for the treatment of bladder tumors,with shorter operation time,fewer perioperative complications and similar rate of recurrence.Besides,it can provide intact specimen for the pathologic diagnosis,plays an important role in the accurate evaluation of tumor stage to predict postoperative prognosis and make treatment plans.