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目的:评价2μm激光治疗非肌层浸润性膀胱肿瘤(NMIBT)的疗效及其与经尿道膀胱肿瘤电切术(TURBt)治疗的优劣。方法:采用TURBt治疗NMIBT患者33例(TURBt组),采用2μm激光治疗NMIBT患者52例(2μm激光组)。其中56例为初发膀胱肿瘤患者;24例为多发肿瘤患者;22例患者至少一处肿瘤直径超过2.5 cm。两组术后常规膀胱灌洗化疗,并每3个月作膀胱镜检查。比较两组手术时间、术后住院时间、并发症及术后肿瘤复发率。结果:85例患者平均手术时间(26.59±11.63)(5～75)min,其中2μm激光组手术时间(24.33±10.10)min,TURBt组(30.15±13.08)min(P=0.034)。TURBt组1例术中膀胱穿孔,2例术后出血;2μm激光组未出现围手术期并发症。术后留院时间2μm组为(3.19±0.93)天,TURBt组为(3.83±1.82)天(P=0.067)。术后3个月TURBt组中1例出现肾积水,2μm激光组中1例出现肾输尿管反流,1例尿道外口狭窄。随访(15.45±8.08)(3～39)个月,21例肿瘤复发,其中19例肿瘤复发于术后12月内。2μm激光组术后3、6、9、12个月分别有0、4、5、1例复发,1年肿瘤复发率为19.23%;TURBt组术后3、6、9、12个月分别有1、2、4、2例肿瘤复发,复发率为27.27%。2μm激光组肿瘤复发率及并发症发生率与TURBt组无显著差别。结论:2μm激光与传统TURBt相比,可有效提高手术安全性及患者手术耐受力,明显缩短手术时间,减少患者术后留院时间,但对NMIBT的疗效并无明显优势,仍有一定局限性。
Objective: To evaluate the efficacy of 2 μm laser in the treatment of non-muscle invasive bladder tumor (NMIBT) and its correlation with transurethral resection of the bladder tumor (TURBt). Methods: TURBt was used to treat 33 patients with NMIBT (TURBt group) and 52 patients (2μm laser group) were treated with 2μm laser. Of these, 56 were newly diagnosed bladder cancer patients; 24 were multiple tumor patients; and at least one of the 22 patients had a tumor diameter of more than 2.5 cm. Two groups of conventional bladder irrigation chemotherapy, and every 3 months for cystoscopy. The operation time, postoperative hospital stay, complications and postoperative tumor recurrence rate were compared between the two groups. Results: The average operation time was (85.5 ± 11.63) (5 ~ 75) min in 85 patients, including 2μm laser group (24.33 ± 10.10) min and TURBt group (30.15 ± 13.08) min (P = 0.034). In the TURBt group, 1 case had perforation of the bladder and 2 cases had postoperative bleeding. There was no perioperative complications in the 2 μm laser group. The duration of postoperative stay in the 2μm group was (3.19 ± 0.93) days and in the TURBt group was (3.83 ± 1.82) days (P = 0.067). One case of hydronephrosis occurred in the TURBt group 3 months after operation, and one case had renal ureter reflux in the 2 μm laser group, while one case had urethral stricture. Follow-up (15.45 ± 8.08) (3 ~ 39) months, 21 cases of tumor recurrence, of which 19 cases of tumor recurrence within 12 months after surgery. There were 0, 4, 5 and 1 recurrences at 3, 6, 9 and 12 months after laser in 2μm laser group, respectively, and the recurrence rate at 1 year was 19.23%. In 3, 6, 9 and 12 months after laser in TURBt group, 1,2,4,2 cases of tumor recurrence, the recurrence rate was 27.27%. The tumor recurrence rate and complication rate in 2μm laser group were not significantly different from TURBt group. CONCLUSION: Compared with traditional TURBt, 2μm laser can effectively improve the safety of operation and patient tolerance, significantly shorten the operation time and reduce the duration of postoperative hospital stay. However, the effect of NMIBT is not obvious and there are still some limitations Sex.