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侵犯输尿管口型膀胱癌电切术中放置输尿管支架的技术改良
引用本文:郭宇文,王志鹏,张健,张路加,朱一辰.侵犯输尿管口型膀胱癌电切术中放置输尿管支架的技术改良[J].国际外科学杂志,2017,44(6).
作者姓名:郭宇文  王志鹏  张健  张路加  朱一辰
作者单位:首都医科大学附属北京友谊医院泌尿外科,北京,100050
摘    要:目的 研究改良后的经尿道膀胱肿瘤电切术术中放置输尿管支架技术的有效性和安全性.方法 共选取首都医科大学附属北京友谊医院泌尿外科于2014年3月-2016年6月收治的侵犯输尿管管口的肌层浸润性膀胱癌患者17例,利用随机数字表法将患者分为两组:(1)改良组(A组,10例),将输尿管开口部位的肿瘤切至膀胱肌层暴露输尿管开口后,利用电切镜电切襻通道放置输尿管支架管;(2)对照组(B组,7例),同法暴露输尿管开口后,换用普通膀胱镜进行输尿管支架管置入.观察两组患者人口学及肿瘤学基线情况以及相关手术指标,利用t检验、秩和检验和Fisher精确检验对两组数据进行对比研究.结果 A、B两组间肿瘤分期、分级以及最大直径等方面差异均无统计学意义(P>0.05).手术时间A组明显短于B组分别为(39.5±14.8) min和(59.3±16.2)min,P=0.020)],术中视野清晰度评分A组明显优于B组分别为(7.7±1.3)分和(5.9±1.2)分,P=0.010)].手术效果及并发症发病率方面两组之间差异无统计学意义.结论 通过电切镜直接置管法,可以有效提高经尿道膀胱肿瘤电切术中电切输尿管口后放置输尿管支架管的效率,且不增加手术风险.

关 键 词:膀胱肿瘤  输尿管口侵犯  输尿管  支架  技术改良

Modified technique of ureteral stent placement during transurethral resection of bladder cancer invading the ureteral orifice
Guo Yuwen,Wang Zhipeng,Zhang Jian,Zhang Lujia,Zhu Yichen.Modified technique of ureteral stent placement during transurethral resection of bladder cancer invading the ureteral orifice[J].International Journal of Surgery,2017,44(6).
Authors:Guo Yuwen  Wang Zhipeng  Zhang Jian  Zhang Lujia  Zhu Yichen
Abstract:Objective To evaluate the efficacy and safety of modified technique of ureteral stent placement during transurethral resection of bladder tumor.Methods Seventeen patients with muscle invasive bladder cancer invading the ureteral orifice from March 2014 to June 2016 in Beijing Friendship Hospital were randomly divided into two groups.In the modified technique group (group A,n =10),tumor was resected until the ureteral orifice was exposed.Then,a guide wire was placed through the tunnel of Electrode loop and the ureteral stent was placed along the guide wire.In control group (group B,7 cases),after ureteral orifice exposed,the guide wire and ureteral stent was placed with cystoscopy.The demographic,oncological baseline and operative factors were evaluated between two groups.Results There was no difference in tumor grade and maximum diameter between two groups (P > 0.05).The operation time in group A was significantly shorter than that in group B (39.5 ± 14.8)min vs (59.3 ± 16.2) min,P =0.020],and the intraoperative vision clarity score was better in group A as well (7.7 ± 1.3) vs (5.9± 1.2),P =0.010].There was no statistical difference between the two groups in the complication.Conclusions The modified technique can improve the efficiency of ureteral stent placement during transurethral resection of bladder tumor without any risk enhancement.
Keywords:Urinary bladder neoplasms  Ureteral orifice invading  Uretera  Stent  Technique improvement
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