1 470 nm激光经尿道膀胱肿瘤整块切除术与经尿道膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的安全性和有效性比较

Comparison of the efficacy and safety between 1 470 nm laser en bloc resection of bladder tumor and transurethral resection of bladder tumor in treatment of non-muscle-invasive bladder cancer

摘要:

目的 比较1 470 nm激光经尿道膀胱肿瘤整块切除术（1 470 nm-EBRBT）与经尿道膀胱肿瘤切除术（TUR-BT）的安全性和有效性。方法 回顾性分析2018年6月－2021年6月该院收治的85例非肌层浸润性膀胱癌（NMIBC）患者的临床资料，根据手术方式不同，分为1 470 nm-EBRBT组（n = 40）和TUR-BT组（n = 45）。两组患者术后膀胱灌注化疗方案相同。比较两组患者手术安全性、临床疗效、病理结果和肿瘤无复发生存率的差异。结果 两组患者手术均顺利完成。两组患者手术时间、膀胱穿孔发生率和术后迟发性出血发生率比较，差异均无统计学意义（P > 0.05）。1 470 nm-EBRBT组术中出血量较TUR-BT组少，未出现闭孔神经反射，膀胱冲洗时间、尿管留置时间和术后住院时间较TUR-BT组短，差异均有统计学意义（P < 0.05）。1 470 nm-EBRBT组初次切除病理标本中含逼尿肌的比例高于TUR-BT组，差异有统计学意义（P < 0.05）。两组患者术后1年肿瘤复发率、术后2年肿瘤累积复发率和无复发生存时间比较，差异均无统计学意义（P > 0.05）。结论 1 470 nm-EBRBT治疗NMIBC安全有效，具有病理标本完整、手术并发症少和恢复快等优点，优于传统TUR-BT，值得临床推广应用。

Abstract:

Objective To compare the clinical efficacy and safety of 1 470 nm laser en bloc resection of bladder tumor (1 470 nm-EBRBT) and transurethral resection of bladder tumor (TUR-BT).Methods Clinical data of 85 non-muscle-invasive bladder cancer (NMIBC) patients from June 2018 to June 2021 were analyzed retrospectively. The patients were divided into 1 470 nm-EBRBT group (n = 40) and TUR-BT group (n = 45) according to different surgical methods, the postoperative chemotherapy regimen of bladder perfusion was the same in both groups. The surgical safety, clinical efficacy, pathological results and recurrence free survival rate of two groups were recorded.Results There were no statistically significant differences in operation time, incidence of bladder perforation, and incidence of postoperative delayed hemorrhage between the two groups (P > 0.05). Compared with the TUR-BT group, the 1 470 nm-EBRBT group had less blood loss, shorter bladder irrigation time, catheter indwelling time and postoperative hospital time, and no obturator nerve reflex, the differences were statistically significant (P < 0.05). The proportion of detrusor in the first resected pathological specimens in 1 470 nm-EBRBT group was higher than that in TUR-BT group (P < 0.05). There were no statistically significant differences in tumor recurrence rate of one year, tumor cumulative recurrence rate of two years and recurrence free survival time between the two groups (P > 0.05).Conclusion Compared with traditional TUR-BT, 1 470 nm-EBRBT is a safe and effective method, which has the advantages of complete pathological specimens, fewer complications, faster recovery and so on. Therefore, it is worthy of clinical application.