经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效比较

目的　比较经尿道钬激光切除与经尿道电切治疗浅表性膀胱肿瘤的疗效及安全性。方法　随机选取 32例膀胱肿瘤患者行经尿道钬激光切除 ,另 2 7例行经尿道电切 ,总结两组患者临床资料 ,并对手术时间、导尿管留置时间、术后膀胱冲洗例数、肿瘤复发情况、肿瘤分期、膀胱穿孔例数、尿道外口狭窄发生率等指标进行比较。　结果　钬激光组手术时间 15～ 5 0min ,平均 2 5min ,膀胱穿孔 1例 ;术后无需膀胱冲洗 ;导尿管留置时间 1～ 4d ,所有患者均获得肿瘤分期 ;随访 1年 ,无尿道狭窄 ,复发 7例。电切组手术时间 10～ 5 5min ,平均 2 8min ,膀胱穿孔 6例 ,术后 5例需膀胱冲洗 ,导尿管留置时间 1～ 6d ,7例获得肿瘤分期 ;随访 1年 ,尿道狭窄 3例 ,复发 8例。两组平均手术时间、导尿管留置时间、术后肿瘤复发、尿道狭窄发生率均无明显差异 (P >0 .0 5 ) ,钬激光组获得准确肿瘤分期例数明显多于电切组 ,而膀胱穿孔及术后膀胱冲洗例数明显少于电切组 (P <0 .0 5 )。　结论　钬激光是一种治疗膀胱肿瘤高效、安全的方法 ,在准确判断肿瘤分期、减少膀胱穿孔及减少出血方面比电切更优越。

A comparative study of holmium laser resection and electrocautery transurethral resection for superficial bladder carcinoma

Objective To compare the clinical efficacy and safety of holmium laser resection and electrocautery transurethral resection for bladder tumors. Methods Thirty two cases were randomly assigned to undergo holmium laser resection of bladder tumors (HoLRBT), and 27 cases, standard electrocautery transurethral resection.The mean operative time,in dwelling urethral catheter time,postoperative recurrences, the case number of obtaining tumor stages,and the numbers of postoperative bladder perfusion,bladder perforation and urethral meatal stenosis were compared between the 2 groups. Results For HoLRBT group,the mean operative time was 25 min (range,15 50 min);1 case had bladder perforation; none needed postoperative bladder perfusion;in dwelling urethral catheter time ranged 1 4 d.All the cases obtained tumor stages.Follow up lasted 1 year.No case had urethral stenosis,but 7 developed recurrence.For electrocautery transurethral resection group, the mean operative time was 28 min (range,10 55 min); 6 cases had bladder perforation;5 needed bladder perfusion; in dwelling urethral catheter time ranged 1 6 d.Seven cases obtained tumor stages.Follow up lasted 1 year.Three cases had urethral stenosis,and 8 developed recurrence.The mean operative time, in dwelling urethral catheter time,incidences of urethral meatal stenosis and postoperative recurrence were not significantly different between the 2 groups ( P >0.05).Compared with electrocautery resection group, more cases in HoLRBT group obtained accurate tumor stages, less cases needed bladder perfusion and had bladder perforation ( P <0.05). Conclusions The HoLRBT technique is safe and effective for treatment of bladder tumors.In addition,HoLRBT has more advantages in obtaining accurate tumor stage,reducing the incidence of bladder perforation and the amount of bleeding during operation than conventional electroresection techniques.