经尿道双极等离子电切术与剜除术治疗非肌层浸润性膀胱癌的病例对照研究

目的对比经尿道膀胱肿瘤等离子电切术（TURBT）与经尿道膀胱肿瘤等离子剜除术（TUEBT）治疗非肌层浸润性膀胱肿瘤（NMIBT）的临床疗效。 方法回顾性分析中山大学附属第三医院粤东医院2013年8月至2017年8月的160例经尿道膀胱肿瘤切除的资料，所有患者术前临床分期均为T1N0M0，其中TURBT和TUEBT各80例，采用全麻或腰硬联合麻醉联合闭孔神经阻滞，行经尿道膀胱肿瘤电切或剜除术。 结果术前两组的临床资料差异无统计学意义，两组患者均顺利完成手术，无输血病例。无严重并发症（膀胱穿孔、严重闭孔神经反射）发生。TURBT组和TUEBT组在手术时间、膀胱穿孔率、术后肿瘤病理分级、术后病理T分期、术后随访时间上差异均无统计学意义，而在术中失血（15±7）ml vs（6±2）ml，P<0.05]，住院天数（5.8±2.3）d vs（3.6±1.4）d，P<0.05]，二次电切率（70.00%vs 36.25%，P<0.05），二年内肿瘤复发率（47.50%vs 31.25%，P<0.05）差异有统计学意义。 结论TURBT与TUEBT均是安全、有效的处理NMIBT的手术方法，但TUEBT大多数标本含有肌层，有利于判断分期，减少了二次电切率，缩短住院时间，降低术后复发率。

Comparison of transurethral bipolar plasma kinetic enucleation versus resection for the treatment of non-muscle-invasive bladder cancer: a case control study

ObjectiveTo compare the effectiveness and safety of transurethral bipolar plasma kinetic enucleation with resection for the treatment of non-muscle-invasive bladder cancer(NMIBC). MethodsThe data of 160 patients diagnosed with suspected T1N0M0-NMIBC from August 2013 to August 2018 were analyzed retrospectively. Eighty patients were performed with transurethral bipolar plasma kinetic enucleation of bladder tumor(TUEBT) under the general anesthesia or combined spinal-epidural anesthesia with obturator nerve block. The others were performed with transurethral bipolar plasma kinetic resection of bladder tumor(TURBT). ResultsThere were no statistical difference in preoperative clinical data between the two groups. The procedures were successfully performed in all patients with no patient requiring blood transfusion. No patient had bladder perforation and obturator nerve reflex during procedure. No statistical difference was found in operative time, rate of bladder perforation, postoperative pathological grading, postoperative pathological T staging, and follow-up time between the two groups. There were statistical difference in blood loss (15±7) ml vs (6±2) ml,P<0.05], hospital stay (5.8±2.3) d vs (3.6±1.4) d,P<0.05], the rate of secondary resection of bladder tumor (70.00% vs 36.25%,P<0.05), and tumor reccurence within 2 years (47.50% vs 31.25%,P<0.05) between the two groups. ConclusionTURBT and TUEBT are effective and safe procedures for managing NIMIBC. The operative specimens of TUEBT included bladder detrusor muscle in favor of judging the tumor stage. TUEBT of NIMIBC could reduce the rate of secondary resection of bladder tumor, shorten the hospital stay and decrease tumor recurrent rate compared with TURBT.