经尿道膀胱肿瘤电切的早期常见并发症的评估、处理及其原因分析

目的 评估经尿道膀胱肿瘤电切的早期并发症及其处理方法，分析引起并发症的各种因素。方法 对我院自1980年1月至2000年12月行经尿道电切的膀胱肿瘤患者1136例进行分析和总结，评估其术中及术后早期并发症以及产生因素及其与肿瘤特性的关系。结果 66（5.8%）例患者曾发生术中及术后早期并发症，43（3.8%）例表现为出血；18（1.6%）例膀胱穿孔，其中14（78％）例为腹膜外型穿孔，4（22％）例为腹膜内型穿孔。43例出血患者19例行经尿道内穿镜下电凝止血，24例中患者在膀胱内血凝块冲洗干净后经保守治疗恢复；18例穿孔患者2（11％）例经开放手术治疗，16（89％）例患者经常规则治疗（包括腹腔及下腹部经皮引流）痊愈。未发现膀胱外肿瘤细胞种植的发生。并发症发生率与肿瘤大小及数目显著相关，与肿瘤的分期、分级及生长部位相关不显著。结论 经尿道膀胱肿瘤电切最常见的早期并发症为出血；其次为膀胱穿孔。膀胱穿孔的处理以保守治疗为主，一般不会发生肿瘤细胞种植；大的肿瘤及多发肿瘤电切后发生并发症的几率显著增加。

Early common complications of endoscopic treatment for bladder tumor

Objective To explore the early complications of transurethral resection for bladder cancer and analyze various factors that contribute to its occurrence. Methods From January 1980 and December 2000, 1 136 patients with bladder cancer underwent transurethral resection at our hospital. Intraoperative and immediate postoperative complications of the initial transurethral resection procedure were recorded and correlated with tumor characteristics. Results There were intraoperative and immediate postoperative complications in 66(5.8%) patients. The most common complications were bleeding in 43(3.8%) patients, bladder perforation in 18(1.6%). Perforation was extraperitoneal in 14(78%) cases and intraperitoneal in 4(22%). Of 19(41%) from the 43 bleeding patients were treated with repeated endoscopic coagulations and 24(59%) of them were cured by blood clot removal and other conservative procedures. Open surgery and non open surgery procedures were done in 2(11%) and 16(89%)(including percutaneous peritoneal drainage and percutaneous hypogastric drainage)of the 18 perforation patients, respectively. No case of tumor seeding was found. The incidence of complications significantly correlated with the size and number of tumors but not with tumor stage, grade or location. Conclusion The most common complication of transurethral resection for bladder cancer is bleeding and the second is perforation. Currently bladder perforation should be managed conservatively with a minimal risk of extravesical tumor seeding. Our results imply that tumor size and multiple tumor resection are associated with a higher complication rate.