经尿道针状电极膀胱肿瘤整块切除术与经尿道钬激光膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的治疗效果和安全性比较

目的 评价经尿道针状电极膀胱肿瘤整块切除术与经尿道钬激光膀胱肿瘤切除术治疗非肌层浸润性膀胱癌的治疗效果和安全性。方法 选取首都医科大学附属北京友谊医院自2015年3月至2017年10月收治的113例非肌层浸润性膀胱癌患者，依据手术方法分为针状电极经尿道膀胱肿瘤整块切除术组（针状电极组63例）和钬激光膀胱肿瘤切除术组（激光组50例）。对比两组患者手术时间、术中出血量、膀胱冲洗时间、尿管留置时间、住院时间及术后随访期复发率，所得数据进行统计学分析。结果 113例患者均成功完成手术，无中转开放手术，无输血病例，无膀胱穿孔病例。所有病例病理均可满足病理分期要求，其中Ta期31例，T1期82例。低级别尿路上皮癌77例，高级别尿路上皮癌36例。所有病例术后随访时间3~22个月，平均随访时间（11.4±5.8）个月。针状电极组肿瘤复发6例（9.5%，6/63），激光组复发7例（14%，7/50），两组均无病理分期进展者。两组患者手术时间、术中出血量、膀胱冲洗时间、尿管留置时间、住院时间及术后随访期复发率比较，差异无统计学意义（P>0.05）。结论 经尿道针状电极膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌安全有效，可以有效避免由于闭孔神经反射引起的膀胱穿孔等严重合并症，切除标本满足病理分期要求。

Comparison of efficacy and safety of transurethral pin-shaped electrode en bloc resection of bladder tumor and transurethral holmium laser resection of bladder tumor for non muscle invasive bladder cancer

Objective To evaluate the efficacy and safety of pin-shaped electrode in the transurethral en bloc resection of bladder cancer and transurethral holmium laser resection of bladder tumor for non muscle-invasive bladder cancer.Methods One hundred and thirteen cases with non muscle-invasive bladder cancer treated in Beijing Friendship Hospital from March 2015 to October 2017 were assigned to receive transurethral resection of bladder tumor. All the cases were divided into pin-shaped electrode group(n=63) and laser group(n=50) according to the operation method. The operation time, the amount of bleeding, bladder irrigation time, indwelling catheter time, hospitalization time and the recurrence rate in the follow-up period were compared between the two groups, and the data were statistically analyzed.Results All the cases were successfully undergone operation.There were no cases of open surgery and no cases of blood transfusion and no cases of bladder perforation during the operation. All case pathology can meet the requirement of pathological staging. There were 31 Ta cases and 82 T1 cases. There were 77 low grade tumor cases and 36 high grade tumor cases. All patients were followed up for 3-22 months, with an average of (11.4±5.8) months. The tumor recurrence was found in 6 cases in the pin-shaped electrode group(9.5%,6/63) and 7 cases in the laser group(14%,7/50). There was no progression case during the follow up period. There was no significant difference in the operation time, the amount of bleeding, bladder irrigation time, indwelling catheter time, hospitalization time and the recurrence rate in the follow-up period in the two groups(P>0.05).Conclusion Transurethral pin-shaped electrode en bloc resection of bladder tumor is a safe and effective therapeutic method for non muscle-invasive bladder cancer.It can effectively avoid the bladder perforation caused by the obturator nerve reflex and meet the needs of postoperative pathological diagnosis.