1 470 nm激光悬挑法剜除术治疗非肌层浸润性膀胱肿瘤

目的探讨采用1 470 nm激光悬挑法剜除术治疗非肌层浸润性膀胱肿瘤的疗效及手术技巧。 方法回顾性分析2016年4月至2017年3月我院收治的22例非肌层浸润性膀胱肿瘤患者,采用1 470 nm激光行膀胱肿瘤悬挑法剜除术,即将亚甲蓝稀释溶液用一次性膀胱注射针在距离肿瘤基底边缘2 cm处黏膜下环形多点注射,使基底部与肌层分离,用1 470 nm激光直射光纤,调整激光功率为70～80 W,沿肿瘤周围环形注射标记点切开膀胱黏膜及黏膜下层,此时可见亚甲蓝染色的肿瘤基底部与肌层的分离面,光纤金属保护鞘头端插入分离面,将肿瘤整体从肌层挑起剜除。观察手术时间、出血量、术中术后并发症等指标。 结果22例手术均获成功,手术时间平均（30±9）min,术中出血少,无闭孔神经反射、膀胱穿孔等并发症,术后无需膀胱冲洗,导尿管保留72 h,随访3～18个月,肿瘤无复发、无尿道狭窄及大出血发生。 结论1 470 nm激光"悬挑法"剜除术治疗非肌层浸润性膀胱肿瘤具有手术时间短、出血少、安全性高、肿瘤形态保留完整等优点,是一种安全有效的手术方式。

Clinical application of 1 470 nm laser suspending enucleation for the treatment of non-muscle-invasive bladder tumor

ObjectiveTo To evaluate the clinical efficacy and surgical skills of 1 470 nm-laser suspended enucleation in the treatment of non-muscle-invasive bladder tumors. MethodsClinical data of 22 patients with non-muscle-invasive bladder tumors admitted to our hospital from April, 2016 to March, 2017 were retrospectively analyzed. All patients underwent 1 470 nm-laser suspended enucleation. The diluted methylene blue solution was injected into the submucosal ring 2 cm from the edge of the tumor base with a disposable bladder injection needle to separate the tumor base from the muscle layer. The fiber was directly irradiated with 1 470 nm laser with a laser power of 70-80 W. The bladder mucosa and submucosa were incised along the ring-shaped injection mark surrounding the tumors. Then, the separation plane between the tumor base and the muscle layer stained with methylene blue was observed, and the head end of the metal sheath of optical fiber was inserted into the separation plane to pull the tumor out of the muscle layer for enucleation. The operation time, bleeding volume, intraoperative and postoperative complications were recorded. ResultsThe surgery was successfully performed in 22 cases with an average operation time of (30±9) min. No intraoperative complications such as bleeding, obturator nerve reflex and bladder perforation occurred. No bladder irrigation was required after the operation. The catheter was retained for 72 h. During postoperative follow-up for 3 to 18 months, no recurrence of tumor, urethral stricture or massive bleeding occurred. ConclusionThe 1 470 nm-laser suspended enucleation is an efficacious and safe management of non-muscle-invasive bladder tumors, which has multiple advantages, such as short operation time, mild bleeding, high safety and intact tumor morphology, etc.