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目的:探讨经尿道膀胱肿瘤激光整块切除术治疗非肌层浸润性膀胱癌的技术特点及应用效果。方法:选取2013年6月~2017年4月152例确诊膀胱肿瘤患者,肿瘤临床分期为T_a、T_1(N_0M_0)期。采用经尿道激光整块切除膀胱肿瘤,术前进行膀胱镜检查,明确患者肿瘤部位、数量及大小等基本情况。术中采用激光在距离肿瘤基底1.0cm处对肿瘤进行整块切除,切至膀胱深肌层或者浆膜层。对术中出血、手术时间、膀胱冲洗时间、尿管留置时间、并发症及肿瘤复发率进行评估。结果:手术时间5~30min,平均20min,术中基本无出血,无膀胱穿孔,无闭孔神经反射,无膀胱内液体外渗。留置导尿管1~3d,膀胱冲洗时间0~1d,部分患者行膀胱冲洗。完成随访129例,随访率84.9%,随访时间2~36个月,平均17.5个月,复发率10.9%(14/129)。结论:激光助力经尿道膀胱肿瘤整块切除术安全、精确、有效,能提供足够完整的病理标本,对肿瘤浸润深度、切缘是否阳性进行准确评估,具有创伤小、并发症少、术后恢复快、肿瘤复发风险低等优点,是实现膀胱肿瘤腔内精准治疗的理想方法。
Objective: To investigate the technical characteristics and application of transurethral resection of bladder tumor in the treatment of non-muscle invasive bladder cancer. Methods: 152 patients diagnosed with bladder cancer from June 2013 to April 2017 were selected. The clinical stage of the tumor was T_a and T_1 (N_0M_0). The use of transurethral resection of the bladder tumor of the bladder, cystoscopy before surgery to determine the location of the patient’s tumor, the number and size of the basic situation. Intraoperative laser 1.0cm in the tumor from the tumor at the site of the whole block, cut to the bladder deep muscle or serosa. Intraoperative bleeding, operation time, bladder irrigation time, catheter indwelling time, complications and tumor recurrence rate were evaluated. Results: The operation time was 5 to 30 minutes, with an average of 20 minutes. There was no bleeding during operation, no bladder perforation, no obturator nerve reflex, and no fluid extravasation in the bladder. Indwelling catheter 1 ~ 3d, bladder flushing time 0 ~ 1d, some patients underwent bladder irrigation. Follow-up was completed in 129 cases, with a follow-up rate of 84.9%. The follow-up time ranged from 2 to 36 months (mean, 17.5 months). The recurrence rate was 10.9% (14/129). Conclusion: Laser-assisted transurethral resection of bladder tumor is safe, accurate and effective. It can provide a complete and complete pathological specimen, accurately assess the depth of tumor invasion and whether the margin is positive, with less trauma, less complications and postoperative recovery Fast, low risk of tumor recurrence, is the ideal method for the accurate treatment of intracavitary tumors.