钬激光联合膀胱灌注治疗浅表性膀胱肿瘤(附30例报告)

目的　总结应用钬激光 (Ho :YAG激光 )治疗浅表性膀胱肿瘤的疗效。　方法　采用钬激光经尿道切除肿瘤 ,联合术后膀胱灌注治疗浅表性膀胱肿瘤 30例。男 2 5例 ,女 5例。平均年龄 5 4岁。肿瘤单发 15例、多发 15例。病理分级G1～G2 ,分期T1～T2 。肿瘤直径 0 .2～ 3.5cm。　结果　手术均一次成功 ,术后创面基底及创缘病理检查无残余肿瘤 ,术后均行吡柔比星膀胱灌注化疗。手术时间平均 18min ,术中平均出血量 <15ml,无膀胱穿孔或术后继发性出血等严重并发症。 30例随访 3～ 14个月 ,平均 7.5个月 ,复发 1例 ,复发率 3%。　结论　经尿道钬激光切除膀胱肿瘤操作简单 ,疗效确切 ,术中、术后无严重并发症 ,是治疗浅表性膀胱肿瘤的一种理想手术方法。     

经尿道等离子电切联合钬激光切除治疗膀胱浅表性肿瘤

目的探讨经尿道等离子双极电切联合钬激光切除治疗膀胱浅表性肿瘤的疗效及安全性。方法 2007年5月～2009年5月对70例多发(2～3个)膀胱肿瘤(Ta～T2a)采用英国Gyrus等离子双极电切联合美国科以人Lumenis100W钬激光切除,钬激光550μm光纤由等离子电切镜操作通道置入切除肿瘤,治疗参数为0.5～1.5J/10～25Hz,总功率15～40W,平均32W。对输尿管口外上方易发生闭孔神经反射区域的肿瘤应用钬激光切除肿瘤,自瘤体基底部切除;其他部位肿瘤采用等离子电切,由肿瘤表面逐渐切除肿瘤,直达肌层。结果 70例膀胱肿瘤均一次切除,手术时间10～45min,平均22min。术中无闭孔神经反射、膀胱穿孔发生。术后保留导尿时间1～6d,平均3d。70例随访6～12个月,平均8.4月,复发4例(5.7%)。结论经尿道等离子电切联合钬激光切除膀胱肿瘤疗效确切、安全性高。     

经尿道钬激光切除膀胱肿瘤(附20例报告)

目的探讨经尿道钬激光膀胱肿瘤切除术的临床疗效和安全性。方法对20例膀胱肿瘤（Ta～T2a期）经尿道钬激光膀胱肿瘤切除，其中17例为初发肿瘤，3例为复发肿瘤。激光功率15～40W。小的肿瘤（直径〈1.0cm，窄蒂）直接汽化，大的肿瘤（直径〉1．0cm，宽带）自瘤体基底部切除，再将其周围1～2cm正常组织汽化、烧灼。结果20例膀胱肿瘤均一次切除，手术时间10～70min（直径〉1．0cm，宽蒂），平均30min。术中无闭孔神经反射、膀胱穿孔及水中毒发生，无输血。术后保留导尿时间1～5d，平均3d。16例随访3个月，4例随访半年，平均3．6月，均未见肿瘤复发。结论经尿道钬激光膀胱肿瘤切除疗效确切、安全性高。     

经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效比较

目的　比较经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效及安全性。方法　随机选取 32例膀胱肿瘤患者行经尿道钬激光切除 ,另 2 7例行经尿道电切 ,总结两组患者临床资料 ,并对手术时间、导尿管留置时间、术后膀胱冲洗例数、肿瘤复发情况、肿瘤分期、膀胱穿孔例数、尿道外口狭窄发生率等指标进行比较。　结果　钬激光组手术时间 15～ 5 0min ,平均 2 5min ,膀胱穿孔 1例 ;术后无需膀胱冲洗 ;导尿管留置时间 1～ 4d ,所有患者均获得肿瘤分期 ;随访 1年 ,无尿道狭窄 ,复发 7例。电切组手术时间 10～ 5 5min ,平均 2 8min ,膀胱穿孔 6例 ,术后 5例需膀胱冲洗 ,导尿管留置时间 1～ 6d ,7例获得肿瘤分期 ;随访 1年 ,尿道狭窄 3例 ,复发 8例。两组平均手术时间、导尿管留置时间、术后肿瘤复发、尿道狭窄发生率均无明显差异 (P >0 .0 5 ) ,钬激光组获得准确肿瘤分期例数明显多于电切组 ,而膀胱穿孔及术后膀胱冲洗例数明显少于电切组 (P <0 .0 5 )。　结论　钬激光是一种治疗膀胱肿瘤高效、安全的方法 ,在准确判断肿瘤分期、减少膀胱穿孔及减少出血方面比电切更优越。     

经皮膀胱造瘘输尿管镜下钬激光碎石治疗膀胱结石25例报告

目的探讨经皮膀胱造瘘输尿管镜下钬激光治疗膀胱结石的效果。方法不适宜经尿道途径处理的膀胱结石患者25例,均采用经皮膀胱造瘘输尿管镜下钬激光碎石。结果所有手术均顺利完成,平均手术时间25（15～50）min。术后均有肉眼血尿,平均2（1～7）d消失。无大出血、膀胱穿孔、味道损伤等并发症发生。均获随访,平均6（1～24）个月,无结石复发及尿道狭窄。结论经皮膀胱造瘘输尿管镜下钬激光碎石治疗膀胱结石效果满意,适宜于无法经尿道途径碎石的患者。     

经尿道钬激光切除浅表性膀胱癌的临床体会

目的 探讨经尿道钬激光切除非肌层浸润性膀胱癌的疗效及安全性。方法 对65例采用经尿道钬激光切除治疗的非肌层浸润性膀胱癌患者的临床资料进行分析。该组患者术前膀胱镜活检组织病理均提示低级别尿路上皮癌。结果 65例患者手术均一次成功,平均手术时间22 min（18～45 min）,术中无明显出血、闭孔神经反射、膀胱穿孔,术后无继发性大出血及尿失禁等并发症。术后留置导尿2～3d。术后创面基底及创缘病理检查无残余肿瘤。术后住院2～3d。术后均按常规方法定期吡柔比星膀胱灌注,定期膀胱镜复查。术后随访平均15个月（3～32个月）,2例为膀胱手术区复发,3例为膀胱非手术区再发,复发加再发率为7.7%。再次行钬激光治疗,现仍在随访中,未见复发。结论 经尿道钬激光切除非肌层浸润性膀胱癌操作简便、安全、灵活、创伤小、并发症少、疗效确切。     

肾盂肿瘤根治术中钬激光的应用

目的:探讨联合钬激光技术在肾盂肿瘤根治术中的有效性及安全性.方法:应用钬激光治疗肾盂肿瘤27例,先经腰部切口作患肾输尿管切除术,再经尿道以钬激光作包括输尿管口周围的膀胱袖口状切除术.结果:27例肾盂肿瘤均一次切除,平均手术时间75 min.术后1个月复查膀胱镜见膀胱黏膜修复完整.随访5个月～2年,未见膀胱肿瘤发生.结论:联合钬激光的肾盂肿瘤根治术安全、有效,是腔道泌尿外科微创治疗肾盂肿瘤较好的方法.     

经尿道钬激光联合膀胱灌注治疗浅表性膀胱肿瘤52例

目的：探讨应用钬激光联合膀胱灌注治疗浅表性膀胱肿瘤的方法和效果。方法：对浅表性膀胱肿瘤52例患者应用钬激光经尿道切除肿瘤,术后联合膀胱灌注治疗。结果：全部患者均一次手术成功,手术时间12~55 min,术中无闭孔神经反射发生,无膀胱穿孔及明显出血等严重并发症。随访8~48个月,复发3例。结论：经尿道钬激光切除膀胱肿瘤方法简便,疗效可靠,无严重并发症,是治疗浅表性膀胱肿瘤的一种较理想的方法。     

经尿道钬激光膀胱肿瘤整块切除术联合化疗治疗肌层浸润性膀胱癌27例

目的探讨肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)行经尿道钬激光膀胱肿瘤整块切除(En bloc resection)联合化疗的临床疗效。方法我院2015年6月～2017年12月对27例MIBC(拒绝或无法耐受根治性膀胱切除术)采用经尿道钬激光膀胱肿瘤整块切除,术中沿肿瘤基底周边1 cm环形切除肿瘤,切除深度达膀胱浆膜层,同时创面基底部活检。术后1周丝裂霉素40 mg局部膀胱灌注(1次/周,共8次,后改为1次/月,共1年),吉西他滨1000 mg/m2(第1、8、15天)+顺铂70 mg/m2(第2天)静脉化疗,4周为1个周期,共2～4周期。结果 27例均顺利完成手术,手术时间20～48min,平均32. 4 min。术中膀胱冲洗液量4. 2～9. 6 L,未出现明显出血、闭孔神经反射。术后留置三腔气囊尿管1～3 d。术后病理为浸润性乳头状尿路上皮癌,G1期14例,G2期8例,G3期5例;基底部活检阳性1例。27例术后随访6～24个月,平均13个月,5例(18. 5%)局部复发,首次复发时间3～18个月(中位时间10个月),1例术后13个月死于远处转移,1例术后18个月死于脑血管意外。结论经尿道膀胱肿瘤钬激光整块切除联合化疗治疗MIBC,出血少,副作用轻,病理分期精准,可作为不愿行膀胱癌根治患者的替代治疗方案。     

经尿道2 μm激光膀胱部分切除术治疗膀胱肿瘤的初步探讨

目的 分析应用经尿道2μm激光行膀胱部分切除术治疗膀胱肿瘤的临床特点.方法 采用骶管麻醉,经尿道膀胱镜2μm激光行膀胱部分切除术治疗18例膀胱肿瘤患者,共切除肿瘤21个,肿瘤直径大小1～3 cm.术中用2μm激光沿肿瘤周围全层切开膀胱壁,在肌层与外层结缔组织之间剥离整块膀胱壁,完整切除肿瘤及其基底部膀胱全肌层标本送病理检查.观察手术时间,术中出血情况,术中及术后并发症,肿瘤病理分期以及术后随访.结果 18例患者均可耐受手术,本组患者手术时间5～12 min,平均(7.4±3.3)min;术中出血量极少或几乎不出血,无闭孔神经反射,术后亦无继发出血,1例术后出现尿外渗,给予置管引流;术后肿瘤病理分期:T1期15例患者,共18个肿瘤,T2期:3例患者,共3个肿瘤;术后随访3～6个月,平均4.5个月,无原位复发.结论 2μm激光能对膀胱壁全层进行精确的汽化切割,并且可以在肌层与疏松结缔组织之间进行剥离,在膀胱肿瘤治疗中达到膀胱部分切除的目的 .     

TRANSURETHRAL EN BLOC RESECTION OF BLADDER TUMORS

PURPOSE: Transurethral en bloc resection of bladder tumors is desirable for evaluating the pathological depth of bladder tumors in resected specimens. The safety, technique and effectiveness of en bloc resection of bladder tumors was investigated using a holmium laser or knife electrode. MATERIALS AND METHODS: A total of 35 patients with transitional cell carcinoma of various sizes underwent transurethral en bloc resection with the muscle layer by holmium laser or knife electrode. The holmium laser was used for tumors at the bladder neck, as in prostate resection, while tumors at the bladder wall were treated with a knife electrode. A circular incision was made around the tumor, followed by level incisions beneath it with subsequent tumor retrieval. The circular incision connected marks made about 10 mm. away from the tumor edge and continued until the superficial muscle layer was visualized. The resected 1 piece specimen was grasped with a loop electrode and retrieved. RESULTS: This technique has been used in 35 consecutive patients (50 lesions). Tissue slides crossing the center of the tumor correctly determined the depth of cancer invasion as stages pTa to pT2. No uncontrollable bleeding, perforation or other serious complications occurred. CONCLUSIONS: Transurethral en bloc resection is a safe and useful technique that also provides sufficient material for pathological evaluation.     

Low-power holmium laser for the management of urinary tract calculi, structures, and tumors

BACKGROUND AND PURPOSE: Introduction of the holmium laser has provided an indispensable tool for the management of urinary tract stones, strictures, and superficial urothelial tumors. While full-power holmium lasers are required for laser resection of the prostate, lower-power devices can be utilized for all cases of stone fragmentation and stricture incision and most cases of superficial urothelial tumors. Herein, we report our initial experience in utilizing a low-power holmium laser in our endourologic practice. PATIENTS AND METHODS: Over a 6-month period, we have utilized both low-power (25 W) and full-power (80 W) holmium lasers to fragment urinary tract stones, incise ureteral or urethral strictures, and ablate superficial urothelial tumors. A series of 80 consecutive patients were assessed prospectively. Laser fibers with a diameter of 200 microm and 365 microm were employed with power settings of 6.4 to 10 W. Laser fiber size and power settings were similar for the low- and full-power devices. RESULTS: Overall, 95% of the stones were completely fragmented, with a stone-free rate at 3 months of 92%. All strictures were incised, with a 91% patency rate at 3 months. Complete tumor ablation was attained in 70%, with a tumor-free rate of 60% at 3 months. Results were equivalent for the low- and full-power lasers. The 200-microm laser fiber allowed adequate access throughout the upper urinary tract during flexible ureteroscopy and flexible nephroscopy. The 365-microm laser fiber was employed via rigid and semirigid endoscopes. CONCLUSIONS: A low-power holmium laser supplies adequate fragmentation and incision power for virtually all endourologic cases. It also provides ablative power in most situations. The only current urologic application that cannot be performed with the low-power device is laser prostatic resection, which requires 60 to 80 W of power. The reduced-power holmium laser should be considered as a low-cost alternative for the management of urinary tract stones, strictures, and urothelial tumors, especially in centers where laser prostatic resection is not performed.     

Holmium:YAG laser treatment of recurrent superficial bladder carcinoma: initial clinical experience

PURPOSE: To review our initial experience with the holmium laser in patients with recurrent superficial bladder cancer. PATIENTS AND METHODS: We treated 41 patients having 71 recurrent superficial transitional-cell tumors of the bladder between December 1994 and September 1997 using the holmium:YAG laser under local anesthesia. The laser treatment was carried out as a part of the follow-up flexible cystoscopy protocol, and topical anesthesia was used. The mean follow-up was 14 months (range 3-33 months). RESULTS: There were 13 recurrent tumors in the treated area and 38 recurrences in the untreated areas. Of interest, a subgroup of 10 patients were treated before 1994 with cystodiathermy and later on with the holmium:YAG laser at various times during their follow-up. The local recurrence rate with cystodiathermy was 32% compared with 10% after laser treatment (P = 0.39). A questionnaire study of 33 patients showed complete satisfaction with the treatment. Only 2 (6%) elected to have a further procedure under general anesthesia. In the series, 83% scored their pain as 2 or less of 10 on a visual analog scale. CONCLUSIONS: The absence of complications, high patient satisfaction, and ability to be used in the outpatient setting make the holmium:YAG laser an attractive alternative in the treatment of recurrent superficial cancer of the bladder.     

应用钬激光治疗泌尿外科疾病155例报告

目的：探讨钬激光治疗泌尿系结石、前列腺增生及肿瘤的临床效果。方法：应用钬激光行输尿管镜下碎石29例，膀胱碎石55例，膀胱肿瘤切除45例，前列腺切除16例，腺性膀胱炎8例，尿道狭窄2例。结果：29例输尿管结石中28例碎石成功，55例膀胱结石全部碎石成功；45例膀胱肿瘤均直接汽化；16例前列腺增生中2例行腺体切除，14例直接汽化；8例腺性膀胱亦汽化治愈；2例尿道狭窄病例排尿通畅。无并发症发生。结论：应用钬激光进行输尿管、膀胱碎石，膀胱肿瘤汽化，前列腺腺体切除术或直接汽化等，是安全有效的。     

经尿道电切术与钬激光消融术治疗浅表膀胱肿瘤疗效比较

目的：评价经尿道膀胱肿瘤电切术（TURBT）与钬激光膀胱肿瘤消融术（HLABT）加盐酸表柔比星辅助灌注治疗对浅表膀胱肿瘤（pTa、pT1）的疗效。方法：采用非随机临床对照研究,比较2004年8月～2008年8月采用TURBT（43例）与HLABT（40例）治疗83例浅表膀胱肿瘤患者的并发症及辅助灌注化疗后肿瘤复发率和副反应发生率。所有患者术后6h内即刻灌注盐酸表柔比星50mg,规范持续灌注1年。常规每3个月行膀胱B超及尿细胞学检查,可疑者行尿道膀胱镜检查,6个月一次膀胱镜检查,随访30（12～42）个月。结果：TURBT与HLABT平均手术时间分别为（34．3±16．1）min与（38．5±19．3）min,差异无统计学意义（P〉0．05）。两组手术并发症发生率分别27％（12／43）、12．5％（5／40）,差异有统计学意义（P〈0．01）。两组术后灌注化疗副反应发生率18／43（41．9％）、15／40（37．5％）,差异无统计学意义（P〉0．05）。两组肿瘤复发率分别为23．2％（10／43）和27．5％（11／40）,差异无统计学意义（P〉0．05）。结论：HLABT与TURBT术后盐酸表柔比星辅助灌注治疗浅表性膀胱肿瘤的疗效相当,在手术时间、术后灌注化疗副反应发生率、肿瘤复发率等方面差异无统计学意义,肿瘤分期分级仍是浅表膀胱肿瘤预后主要因素。术后并发症的差异主要来自闭孔神经反射的发生率不同。     

Early complications of endoscopic treatment for superficial bladder tumors

PURPOSE: Bladder tumors are the second most common tumors of the genitourinary system. Approximately 80% of patients initially present with a superficial lesion, which is treated with transurethral resection. Although transurethral resection is a standard procedure, it is not morbidity-free. We assessed the early complications of transurethral resection for superficial bladder cancer and analyzed various factors that may contribute to its occurrence. MATERIALS AND METHODS: Between January 1979 and December 1996, 2,821 patients with superficial bladder cancer underwent transurethral resection at our center. We assessed intraoperative and immediate postoperative complications of the initial transurethral resection procedure, and correlated them with tumor characteristics. RESULTS: Of the 2,821 patients in our study 2,461 (87%) were male and 360 (13%) were female. Average age was 65 years (range 16 to 94). Of the 145 complications (5.1%) the most common were bleeding in 78 patients (2.8%) and bladder perforation in 36 (1. 3%). Perforation was extraperitoneal in 30 cases (83%) and intraperitoneal in 6 (17%). Conservative treatment and open surgery were done in 32 (89%) and 4 (11%) patients, respectively. We noted no case of tumor seeding. A repeat procedure was done in 77 patients (2.7%) with bleeding as the leading cause of repeat intervention in 65 (84%). Blood transfusion was required in 96 cases (3.4%). The incidence of complications significantly correlated with the size and number of tumors but there was no association with tumor stage, grade or location. CONCLUSIONS: The most common complication of transurethral resection for superficial bladder cancer is bleeding. Currently bladder perforation should be managed conservatively with a minimum risk of extravesical tumor seeding. Our results imply that tumor size and multiple tumor resection are associated with a higher complication rate.     

腔内钬激光手术治疗多种复合膀胱病变--507例报告

目的 探讨经尿道钬激光切除膀胱多种复合病变的效果。方法 回顾分析我院2001年8月～2005年9月在镜下经尿道钬激光切除膀胱多种复合病变的临床资料，共507例17种膀胱病变，其中111例同时患2种以上膀胱病变，36例患3种膀胱病变。结果 一期手术505例，二期手术2例。手术时间5～35min，平均20min。无闭孔神经反射，无手术并发症。放置心脏起搏器3例和冠脉支架3例均顺利完成手术。507例随访12～24个月，平均18个月，症状消失，膀胱镜检查无复发。结论 经尿道钬激光切除膀胱多种复合病变安全可靠，可精确控制切除膀胱壁的深度，可作为微创腔内切除膀胱多种复合病变的首选方法。     

Use of the holmium:YAG (Ho:YAG) laser for treatment of superficial bladder carcinoma

This is the first North American report describing the use of the holmium:YAG (Ho:YAG) laser to treat patients with superficial bladder carcinoma. Fifteen patients, with a total of 52 recurrent superficial bladder tumors, underwent endoscopic laser photoablation of their lesions. No intraoperative or delayed complications occurred. At follow-up cystoscopy performed 3 months after lasing, four patients (27%) were without disease; eight patients (53%) had out-of-field recurrences; and three patients (20%) were classified as having in-field recurrences. We conclude that using the Ho:YAG for endoscopic treatment of patients with superficial bladder tumors is both feasible and clinically useful and that the lack of perceived pain or discomfort during lasing, as well as the lack of need for an in-dwelling urethral catheter, makes it advantageous for selected patients over conventional electroresection techniques. © 1994 Wiley-Liss, Inc.     

经尿道Ho：YAG激光治疗浅表性膀胱肿瘤的临床分析（附92例报告）

目的：总结经尿道钬激光（Ho：YAG激光）治疗浅表性膀胱肿瘤的临床体会。方法：2005年7月～2008年2月对92例浅表性膀胱癌患者采用Ho：YAG激光治疗,其中肿瘤单发56例,多发36例。肿瘤直径0．5～4cm。术前病理检查均提示为低级别尿路上皮癌。11例年老和一般情况差者采用局麻。结果：手术均一次成功,术后创面基底及创缘病理检查无残余肿瘤,术后均按常规方法用化疗药物行膀胱灌注,并定期随访,每3个月复查膀胱镜。手术时间平均18min（10～50min）,出血极少,无膀胱穿孔及术后继发出血等并发症。术后留置导尿1～3天,最短14h。局麻患者术后即可进食并起床活动。术后住院1～3天,其中43例为Et间手术（入院当天手术,第2天出院）。术后随访平均15个月（2～31个月）,12例复发（13．3％）,再次激光或电切治疗。结论：经尿道Ho：YAG激光治疗浅表性膀胱癌安全,微创,患者耐受性好,疗效与传统TURBT相似。