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目的探讨局部麻醉下门诊膀胱镜检查中2μm激光气化切除单发非肌层浸润性膀胱肿瘤的安全性和可行性。方法在尿道局部麻醉下,经膀胱镜检查发现的单发、带蒂、直径小于3 cm的膀胱肿瘤患者30例,直接采用2μm激光气化切除。并在膀胱镜检查及激光气化切除过程中对患者进行NRS疼痛评分。术后2 h给予表阿霉素膀胱灌注,定期灌注随访。结果组织病理学检查结果显示,尿路上皮癌Ⅰ级25例,尿路上皮癌Ⅰ～Ⅱ级3例,内翻性乳头状瘤2例。膀胱镜检查时NRS疼痛评分:2分12例,3分18例;激光切除时疼痛评分:4分5例,5分13例,6分12例。术中无闭孔神经反射及膀胱穿孔等手术并发症。术后6～24个月随访,所有患者创面愈合良好,无原位复发,2例患者异位复发。结论在门诊局部麻醉行膀胱镜检查的条件下,采用2μm激光气化切除非肌层浸润膀胱肿瘤的方法是安全、可行的,大大降低了患者的痛苦。
Objective To investigate the safety and feasibility of 2 μm laser vaporization resection of single non-muscular invasive bladder tumor in out-patient cystoscopy under local anesthesia. Methods Thirty patients with solitary or pedical bladder tumors less than 3 cm in diameter under cystoscopy under local urethral anesthesia were directly resected by 2 μm laser vaporization. Patients underwent NRS pain scores during cystoscopy and laser gasotomy. Epirubicin was given intravesical instillation 2 h after operation, followed by regular perfusion. Results The results of histopathological examination showed that there were 25 cases of grade Ⅰ in urothelial carcinoma, 3 cases of grade Ⅰ ~ Ⅱ in urothelial carcinoma and 2 cases of inverted papilloma. Cystoscopy NRS pain score: 2 points in 12 cases, 3 points in 18 cases; laser excision pain score: 4 in 5 cases, 5 points and 13 cases, 6 points and 12 cases. Intraoperative closed-hole nerve reflex and bladder perforation and other surgical complications. After 6 months to 24 months follow-up, all patients had a good wound healing, no recurrence in situ, and 2 patients had ectopic recurrence. Conclusion Under the condition of out-patient local anesthesia under cystoscopy, it is safe and feasible to use 2μm laser vaporization to remove non-muscular invasion of bladder tumor, which greatly reduces the patient’s pain.