钬激光膀胱肿瘤切除术疗效的临床研究

目的：探讨经尿道钬激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术对非肌浸润性膀胱肿瘤复发率的影响。方法选择2006年1月至2013年9月间，有完整临床及随访资料的100例非肌层浸润性膀胱尿路上皮肿瘤患者，非随机分为2组，每组各50例，分别行经尿道钬激光膀胱肿瘤切除术及电切术，两种手术方法及术后处理分别采用统一的标准，根据术后病理分类，其中经尿道钬激光手术组，低危、中危、高危分别为29例、13例、8例，经尿道电切手术组，低危、中危及高危分别为26例、14例、10例，对术后复发率进行比较。结果随访6~84个月，中位时间35个月，钬激光手术组低危患者复发率10.3%，中危患者复发率23.1%，高危患者复发率37.5%，电切手术组低危患者复发率19.2%，中危患者复发率28.6%，高危患者复发率40%。两组低、中危组复发率有明显差异（P＜0.05），高危患者复发率无明显差异（P＆gt;0.05）。结论经尿道钬激光膀胱肿瘤切除术效果好，在低、中危膀胱肿瘤患者治疗中复发率优于电切术，高危患者有相似的疗效，可替代电切术成为新的标准方式。

Clinical study of efficacy with Holmium laser resection of bladder tumor

Objective To study efective of the recurrence rate with non invasive bladder urothelial tumor treatment by Holmium laser resection of bladder tumour and transurethral resection of bladder tumor. Methods Select 100 cases of non -muscle invasive bladder urothelial tumors with complete date from January 2006 to September 2013,Divided into two groups nonrandom,50 cases one group, treatment by Holmium laser resection of bladder tumour and transurethral resection of bladder tumor,each surgical method and treatment postopration use the same standard,Classification according pathological findings postopration,compare the recurrence rate the group of Holmium laser opreation,29 case with low-risk,15 cases with medium-risk and 6 cases with high-risk,another proup,24 cases with low-risk,14 cases with medium-risk and 12 cases with high-risk. Results Follow up for 6-84 months （median 35 months）,the recurrence rate treated by Holmium laser operation is low-risk with 17.2%（5/29）, medium-risk with 26.7 %（4/15）and high -risk with33.3%（3/6）,and the recurrence rate treated with transurethral resection of＆amp;nbsp;electhrsurgical is low-risk with 25.0% （6/24）,medium-risk with 35.7%（5/14）and high-risk with 28.5%（4/14）.Significant differences of the recurrence rate in cases of low-risk and of medium-risk treaed by Holmium laser opreation and electhrsurgical opreation,nonsignificant differences of the recurrence rate in cases of high-risk. Conclusions Efficacy the treatment of non-muscle invasive bladder urothelial tumors with Holmium laser resection is better,the recurrence rate in cases of low-risk and of medium-risk treaed by Holmium laser opreation lower, and the recurrence rate treaed by electhrsurgical operation is higher, and similar efficacy in cases of high-risk teated by two surgical methods. Holmium laser resection of bladder tumor can instead of transurethral resection of bladder tumor.