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目的:通过与经尿道膀胱肿瘤切除术(TURBT)比较,探讨2μm连续式激光治疗初发非肌层浸润性膀胱肿瘤(NMIBC)的可行性。方法:通过前瞻性随机化分组方法,将2006年1月~2010年12月收治入院的400例初发膀胱肿瘤患者分为TURBT组及2μm连续式激光治疗组(TULVBT组),TURBT组行标准TURBT,TULVBT组采用2μm连续式激光汽化处理膀胱肿瘤后,以环形附件清理肿瘤基底部焦痂,随后改以膀胱镜行基底部活检。对疑有首次腔内手术肿瘤残余或术后病理缺少膀胱肌层者,于术后3~4周行重复TURBT(reTURBT)。所有患者每3个月随访膀胱镜至术后2年,随后改为每6个月1次。结果:共292例患者纳入本项研究,其中TURBT组143例,TULVBT组149例,两组肿瘤相关资料的差异无统计学意义(P>0.05)。TURBT组手术时间(28.43±13.19)min,TULVBT组(31.51±12.80)min(P=0.044)。TURBT组中6例因闭孔反射致膀胱穿孔,其中1例中止手术,TULVBT组未出现严重术中并发症。44例接受re-TURBT,TURBT组17例(11.9%),TULVBT组27例(18.1%)(P=0.137),其中因切除物病理无肿瘤下膀胱肌层27例,TURBT组9例(6.3%),TULVBT组18例(12.1%)(P=0.088)。129例36个月内出现肿瘤复发,TURBT组61例(42.7%),TULVBT组68例(45.6%)(P=0.608)。平均无肿瘤复发生存时间TURBT组为(25.46±13.18)个月,TULVBT组(24.88±12.85)个月(P=0.729)。19例肿瘤进展,TURBT组11例(7.7%),TULVBT组8例(5.4%)(P=0.421)。结论:2μm连续式激光可作为治疗初发NMIBC的手段,辅以常规膀胱镜下活检即可获得较完整的肿瘤病理资料,可获得与TURBT相似的治疗效果。
OBJECTIVE: To investigate the feasibility of 2 μm continuous laser in the treatment of non-muscular invasive bladder tumor (NMIBC) compared with transurethral resection of bladder tumor (TURBT). Methods: 400 patients with primary bladder cancer who were admitted to hospital from January 2006 to December 2010 were divided into TURBT group and 2μm continuous laser group (TULVBT group) by prospective randomized grouping method. TURBT group TURBT, TULVBT group using 2μm continuous laser vaporization of bladder cancer, the annular attachment to clean the esophageal base eschar, and then changed to cystoscopy biopsy. Repeat suspected TURBT (reTURBT) was performed at 3 to 4 weeks after the first intracavitary tumor resection or postoperative pathological absence of bladder myomectomy. All patients were followed up for cystoscopy every 3 months until 2 years after surgery, then changed every 6 months. Results: A total of 292 patients were enrolled in this study. Of 143 patients in TURBT group and 149 in TULVBT group, there was no significant difference in tumor-related data between the two groups (P> 0.05). The operation time in TURBT group was (28.43 ± 13.19) min, in TULVBT group (31.51 ± 12.80) min (P = 0.044). TURBT group, 6 cases of bladder perforation due to obturator reflex, including 1 case of surgery, TULVBT group did not appear serious intraoperative complications. Forty-four patients underwent re-TURBT, 17 (11.9%) with TURBT and 27 (18.1%) with TULVBT (P = 0.137) %), TULVBT group 18 cases (12.1%) (P = 0.088). Tumor recurrence occurred in 129 patients within 36 months, with 61 (42.7%) in the TURBT group and 68 (45.6%) in the TULVBT group (P = 0.608). The average tumor-free survival time in TURBT group was (25.46 ± 13.18) months and in TULVBT group (24.88 ± 12.85) months (P = 0.729). Tumor progression occurred in 19 patients, with 11 (7.7%) in the TURBT group and 8 (5.4%) in the TULVBT group (P = 0.421). CONCLUSION: A 2μm continuous laser can be used as a treatment for initial NMIBC. A complete cytopathological data can be obtained with conventional cystoscopic biopsy, and the similar therapeutic effect to TURBT can be obtained.