超脉冲等离子二步法治疗侧壁浅表性膀胱肿瘤

目的：探讨经尿道超脉冲等离子电切加气化相结合二步法切除侧壁浅表性膀胱肿瘤的安全性和有效性。方法：采用英国Gyrus公司第三代超脉冲等离子电切气化系统行经尿道超脉冲等离子电切加气化相结合二步法切除侧壁浅表性膀胱肿瘤（PKRVBt）78例。男51例，女27例，平均年龄55．7（34～72）岁。膀胱肿瘤单发42例，多发36例，膀胱肿瘤侧壁有分布者78例。术前均予膀胱镜检查活检病理证实为移行细胞癌，G1期17例．G2期61例，CT检查均为浅表性膀胱肿瘤。结果：经尿道超脉冲等离子电切加汽化相结合切除侧壁浅表性膀胱肿瘤（PKRVBt）手术时间16～65min，平均（36±14）min，术中术后无明显出血。78例侧壁膀胱肿瘤切除时，早期2例发生闭孔神经反射后伴腹膜外型的膀胱壁穿孔，无电切综合症，无严重出血发生。随访12个月，9例复发并再行PKRVBt。结论：经尿道超脉冲等离子电切加气化相结合二步法切除侧壁浅表性膀胱肿瘤的方法。可有效避免闭孔神经反射、膀胱穿孔、严重出血等并发症的发生，是一种安全、有效的手术方式。

Ultrapulse Plasmakinetic with Two Steps for Lateral Superficial Bladder Tumor

Objective:To evaluate the clinical efficacy and safety of transurethral ultrapulse plasmakinetic vaporized resection of lateral superficial bladder tumor with two steps(PKRVBt).Method:78 cases with lateral superficial bladder tumor(17 Gl and 61 G2) were treated by PKRVBt.There were male 51 and female 27 between 34 and 72 years old(mean 55.7 years).All patients were performed with cystoscopy and CT scan preoperatively.Result: The mean duration of the procedure was 36±14 mins(16 to 65 mins) with slight bleeding.No TURS and severe bleeding were found,two cases underwent bladder perforation in early stage of PKRVBt method.all patients were followed up in 12 months,tumor recurrence were found in nine cases and received PKRVBt procedure again. Conclusion:Trans-urethral ultrapulse plasmakinetic vaporized resection of lateral superficial bladder tumor with two steps is effective and safe,obturator nerve reflection and bladder perforation could be avoided.