摘要
目的:探讨利用经尿道内镜下注射针行膀胱肿瘤黏膜下剥离后再行经尿道膀胱肿瘤整块电切术治疗非肌层浸润性膀胱肿瘤的安全性和有效性。方法:收集2017年1月~2018年12月我院收治的63例影像学或膀胱镜检查考虑为非肌层浸润性膀胱肿瘤患者,先在膀胱镜下利用经尿道内镜下注射针行膀胱肿瘤黏膜下剥离后,再改电切镜行经尿道膀胱肿瘤整块切除治疗膀胱肿瘤病灶。记录患者手术时间、术中出血量、膀胱冲洗时间、尿管留置时间、术后住院时间、术后病理分级和6个月及12个月肿瘤复发率。结果:其中61例顺利完成,2例因黏膜下剥离后出血,视野不清行常规电切。肿瘤直径1.0~4.0 cm,完整取出肿瘤58例,切开取出5例。手术时间(46.0±18.2)min,膀胱冲洗时间(23±8)h,尿管留置时间(4.8±1.8)d,术后住院时间(6.1±1.8)d。无一例需要输血,1例发生闭孔神经反射,无穿孔及术后出血等并发症。术后病理:Ta期47例,T1期14例,T2期2例。48例随访6个月,均未见复发;其中29例随访至12个月,2例复发。结论:利用经尿道内镜下注射针行膀胱肿瘤黏膜下剥离后整块电切治疗非肌层浸润性膀胱肿瘤是一种安全有效的方式。肿瘤的完整切除有利于病理学的评估,对肿瘤的后续治疗具有更精确的指导意义。完整切除膀胱肿瘤的方法更符合肿瘤外科治疗原则。虽然我们的手术方式需分步进行,但本手术的设备常规,易于开展,尤其在基层医院,这是本手术的一大优点。
Objective:To study the safety and efficacy of transurethral resection of bladder tumor following submucosal dissection of tumors using endoscopic injection needle with cystoscopy.Method:Between January 2017 and December 2018,sixty-three patients with non-muscle-invasive bladder cancer diagnosed by imaging or cystoscopy were included in Urological Surgery Department of People’s Hospital of Quzhou.Submucosal dissection of bladder tumors was performed utilizing injection needleswith cystoscopy,followed by transurethral resection of bladder tumor.The duration of operation,blood loss,the duration of bladder irrigation,catheter retention time,postoperative hospitalstay,pathological grade and tumor recurrence rate after 6 months and 12 months were recorded.Result:Among them,61 cases were successfully completed the operation.Another 2 cases underwent conventional TURBT due to bleeding and unclearfield of vision.Diameter of tumors ranged from 1.0 cm to 4.0 cm.Tumors were removed by en-bloc resectionin 58 cases and the remaining 5 cases received piecemeal resection.Operation time was(46.0±18.2)minutes,and bladder irrigation time was(23±8)hours.Urinary catheter retention time was(4.8±1.8)days,and hospital stay was(6.1±1.8)days.None of the cases required blood transfusion.No perforation,postoperative bleeding or other complications happened except that 1 case presented obturator nerve reflex.Postoperative pathology:47 patients were in Ta stage,14 in T1 and 2 in T2.None of the 48 cases had tumor recurrence over the 6 months of follow-up period.Among them,29 cases were followed up for 12 months,and 2 of themhad been reported to relapse.Conclusion:It is a safe and effective way to treat the non-muscle-invasive bladder tumor withtransurethral resection of bladder cancer following the submucosal dissection of bladder tumor usingcystoscopic injection needle.The complete resection of tumor is beneficial to the evaluation of pathology with more precise guiding for subsequent treatment.Complete removal of the bladder tumor is more consistent with the principles of surgical management.Though our surgical methods need to be performed step by step,the equipmentis easily accessed and the operation is easy to be carried out,especially in the primary hospital,which is one of the advantages of this operation.
作者
祝秀文
万里军
童炎岳
ZHU Xiuwen;WAN Lijun;TONG Yanyue(Department of Urology,People's Hospital of Quzhou,Quzhou,Zhejiang,324000,China)
出处
《临床泌尿外科杂志》
2020年第3期224-226,共3页
Journal of Clinical Urology
关键词
非肌层浸润性膀胱癌
经尿道内镜下注射针
内镜下黏膜剥离
肿瘤整块切除
non-muscle-invasive bladder cancer
injection needle under urethral endoscope
endoscopic submucosal dissection
en-bloc resection of bladder tumor
