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目的:探讨经尿道2μm激光同期切除膀胱肿瘤和BPH的疗效及安全性。方法:回顾性分析2008年1月~2012年12月187例老年男性膀胱肿瘤患者,将其分为两组,第1组119例单纯行经尿道2μm激光膀胱肿瘤切除术,第2组68例在行经尿道2μm激光膀胱肿瘤切除术的同时行经尿道2μm激光前列腺切除术。分别比较了两组患者术前的临床特征、病理特征、手术时间和出血量,以及两组患者手术前后尿流率,剩余尿的变化情况,肿瘤复发及进展情况。结果:两组患者在年龄、临床分期、肿瘤大小和数量方面没有明显的差异,术后病理分级也无统计学差异,第2组患者在手术时间、术中失血、尿管留置时间上均较第1组长。两组随访时间中位数分别为35.3个月(第1组)和32.5个月(第2组),第2组的尿流率较术前及第1组显著升高,同时剩余尿较第1组明显降低,第2组复发率为29.41%,较第1组的36.97%有显著差异,比较发现单发的或小于3cm的肿瘤患者其肿瘤复发率低于多发的或肿瘤>3cm的患者。同时两组均未在膀胱颈部及尿道前列腺部发现有肿瘤复发。结论:对于伴有下尿路梗阻症状的非肌层浸润性膀胱肿瘤患者,采用2μm激光同时经尿道切除膀胱肿瘤和BPH是安全可靠的,不会增加膀胱颈部和前列腺尿道部肿瘤种植的风险。同时在解除膀胱颈部的梗阻后,能降低或延缓膀胱肿瘤的复发。
Objective: To investigate the efficacy and safety of transurethral 2μm laser simultaneous resection of bladder tumor and BPH. Methods: A total of 187 elderly male patients with bladder cancer from January 2008 to December 2012 were retrospectively analyzed. The patients in group 1 were treated by transurethral resection of 2 μm laser bladder tumor in 119 cases. The second group of 68 patients Transurethral 2um laser bladder tumor resection while transurethral 2um laser prostatectomy. Preoperative clinical features, pathological features, operative time and bleeding volume were compared between the two groups. Urinary flow rate, residual urine changes, tumor recurrence and progression before and after operation were compared between the two groups. Results: There was no significant difference between the two groups in terms of age, clinical stage, tumor size and number, and postoperative pathological grading. There was no significant difference between the two groups in operation time, intraoperative blood loss and catheter indwelling time The first group leader. The median follow-up time was 35.3 months (group 1) and 32.5 months (group 2), respectively. The urinary flow rate in group 2 was significantly higher than that in group 1 and group 1, 1 group was significantly lower, the recurrence rate of the second group was 29.41%, compared with 36.97% of the first group were significantly different found in patients with solitary or less than 3cm tumor recurrence rate was lower than those with multiple or tumor> 3cm patients . At the same time, both groups did not find tumor recurrence in the bladder neck and urethra prostate. Conclusions: Simultaneous transurethral resection of the bladder tumor and BPH with 2 μm laser is safe and reliable for patients with non-muscle invasive bladder cancer with lower urinary tract obstruction and does not increase the risk of bladder neck and prostate urethra tumor implantation . At the same time in the lifting of the bladder neck obstruction, can reduce or delay the recurrence of bladder cancer.