半导体激光联合吉西他滨膀胱灌注治疗非肌层浸润性膀胱肿瘤

目的 探讨经尿道半导体激光膀胱肿瘤整块切除术联合吉西他滨膀胱灌注化疗治疗非肌层浸润性膀胱肿瘤的手术方法并评估其安全性和有效性.方法 2014年7月至2015年7月采用经尿道半导体激光膀胱肿瘤整块切除术治疗非肌层浸润性膀胱肿瘤患者62例,术后定期行吉西他滨膀胱灌注化疗.记录手术时间、术中出血情况、手术并发症、膀胱持续冲洗时间、留置尿管时间、术后住院天数及术后复发情况等.结果 手术平均时间为(30.5±12.8)min,术中出血少,均未出现闭孔神经反射、膀胱穿孔、水中毒、尿外渗、继发性出血等并发症,术后平均膀胱冲洗时间为(6.15 ±2.33)h,术后平均留置尿管时间为(7.33±1.54)d,术后平均住院时间为(8.21±1.26)d.术后随访6～18个月,3例异位复发.结论 经尿道半导体激光膀胱肿瘤整块切除术联合吉西他滨膀胱灌注治疗非肌层浸润性膀胱肿瘤的方法安全有效,并且该术式能够提供肿瘤准确分级、分期信息,值得临床推广应用.

The clinical research of transurethral diode laser en bloc resection combined with gemcitabine intravesical chemotherapy for non-muscle invasive bladder tumor

Objectives To evaluate the safety and efficacy of transurethral diode laser en bloc resection combined with gemcitabine intravesical chemotherapy for the treatment of non-muscle invasive bladder tumor.Methods From July 2014 to July 2015,clinical data of 62 patients with non-muscle invasive bladder tumor were retrospectively analyzed.All patients received transurethral diode laser en bloc resection and gemcitabine intravesical chemotherapy.The operative time,intraoperative blood loss,incidence of operative complications,bladder irrigation time,days for urethral catheterization,duration of hospitalization after surgery and recurrence were recorded.Results The mean operative time was (30.5 ± 12.8) min with less amount of blood loss,and the obturator nerve reflex,perforation,water intoxication,urinary leakage and secondary hemorrhage did not occur.The mean time of bladder irrigating was (6.15 ± 2.33) h,the mean time of catheterization was (7.33 ± 1.54) d and the mean time of hospitalization after surgery was(8.21 ± 1.26) d.Patients were followed up for 6 to 18 months,with 3 cases of ectopic recurrence.Conclusions Transurethral diode laser en bloc resection combined with gemcitabine intravesical chemotherapy for the treatment of non-muscle invasive bladder tumor is safe and effective.The operation can provide accurate tumor classification and staging information,and it is worthy of wide clinical application.