1470 nm激光经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效观察（附55例报告）

摘要：目的??探讨1470 nm激光经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌（NMIBC）的安全性和有效性。方法?2015年10月－2017年2月该院对55例膀胱癌患者采用1470 nm激光经尿道膀胱肿瘤整块切除术。术前行膀胱镜检查明确肿瘤部位、数量、大小及蒂部情况，术前肿瘤临床分期为TaN0M0或者T1N0M0。采用1470 nm激光将肿瘤自基底部整块切除，深达膀胱肌层或外膜层。术后辅助使用吡柔比星膀胱灌注1年。结果?该组患者均顺利完成手术。手术时间10～38 min，平均20 min，术中冲洗液清亮，未发生闭孔神经反射，无膀胱穿孔。术后常规持续膀胱冲洗1 d，留置导尿管3～7 d，术后住院时间为5～8 d，病理性质为尿路上皮癌，术后病理分期Ta期23例、T1期31例、T2期1例。随访时间6～30个月，平均15个月，4例复发（7.3%），均非原位复发。结论?1470 nm激光经尿道膀胱肿瘤整块切除术治疗NMIBC安全、有效，能提供相对完整的病理标本，值得临床推广应用。

Clinical observation of en bloc transurethral resection of bladder tumor by 1470 nm laser in treatment of non-muscle-invasive bladder cancer (55 cases)

Abstract: Objective?To evaluate the safety and efficacy of en bloc transurethral resection of bladder tumor by 1470 nm laser in treatment of non-muscle-invasive bladder cancer.?Methods?The clinical data of 55 patients with bladder cancer received en bloc transurethral resection of bladder tumor by 1470 nm laser from October 2015 to February 2017 were analyzed. Preoperative cystoscopy was performed to confirm the location, numbers, size, and pedicle of the tumors. The preoperative clinical stages were TaN0M0 or T1N0M0. By using 1470 nm laser, the en bloc transurethral resection was performed until the deep muscularis or the adventitia layer. The intravesical instillation of pirarubicin was performed for one day postoperatively.?Results?All the patients underwent operations successfully, the operative time was 10 ~ 38 min (mean, 20 min). Flushing fluid color was constantly clear during operation. The obturator nerve reflex and perforation did not occur. All the patients had catheter indwelled for 3 ~ 7 days, and 5 ~ 8 days hospital stay after the operation. The pathological diagnosis was urothelial carcinoma. Postoperative pathological stages of enrolled cases were distributed as 23 cases of Ta staging, 31 cases of T1 staging, and one case of T2 staging. 55 cases were followed up for 6 ~ 30 months (mean, 15 months). The recurrence rate was 7.3% (4/55).?Conclusion?En bloc transurethral resection of bladder tumor by 1470 nm laser in the treatment of non-muscle-invasive bladder cancer is safe and effective, with comparatively complete specimens for pathological evaluation, it is worthy of clinical application.