经尿道电切术与钬激光消融术治疗浅表膀胱肿瘤疗效比较

目的：评价经尿道膀胱肿瘤电切术（TURBT）与钬激光膀胱肿瘤消融术（HLABT）加盐酸表柔比星辅助灌注治疗对浅表膀胱肿瘤（pTa、pT1）的疗效。方法：采用非随机临床对照研究，比较2004年8月～2008年8月采用TURBT（43例）与HLABT（40例）治疗83例浅表膀胱肿瘤患者的并发症及辅助灌注化疗后肿瘤复发率和副反应发生率。所有患者术后6h内即刻灌注盐酸表柔比星50mg，规范持续灌注1年。常规每3个月行膀胱B超及尿细胞学检查，可疑者行尿道膀胱镜检查，6个月一次膀胱镜检查，随访30（12～42）个月。结果：TURBT与HLABT平均手术时间分别为（34．3±16．1）min与（38．5±19．3）min，差异无统计学意义（P〉0．05）。两组手术并发症发生率分别27％（12／43）、12．5％（5／40），差异有统计学意义（P〈0．01）。两组术后灌注化疗副反应发生率18／43（41．9％）、15／40（37．5％），差异无统计学意义（P〉0．05）。两组肿瘤复发率分别为23．2％（10／43）和27．5％（11／40），差异无统计学意义（P〉0．05）。结论：HLABT与TURBT术后盐酸表柔比星辅助灌注治疗浅表性膀胱肿瘤的疗效相当，在手术时间、术后灌注化疗副反应发生率、肿瘤复发率等方面差异无统计学意义，肿瘤分期分级仍是浅表膀胱肿瘤预后主要因素。术后并发症的差异主要来自闭孔神经反射的发生率不同。

The Curative Effects of Superficial Bladder Tumor: Comparison Between Transurethral Resection of Bladder Tumors and Holmium Laser Ablation of Bladder Tumors

Objective：To evaluate the curative effect of superficial bladder tumor by transurethral resection of bladder tumors （TURBT） and holmium laser ablation of bladder tumors （HI.ABT）. Methods：83 cases of superficial bladder tumor were treated by TURBT（43/83） and HLA（40/83） who received an immediate postoperative and Continuing intravesical chemotherapy, with 50 mg intravesical epirubicin hydrochloride in 6 hours after surgeryfrom 2004 to 2008. The complications, the secondary tumor recurrence after chemotherapy infusion and the incidence of side effects were compared. Type B-ultrasonic and urine cytology examination were performed every 3 months routinely. Suspicious persons were performed urethral cystoscopy every six-monthly, and the follow-up was 30 （12-42） months. Results： Comparison between TURBT and HLABT ： the average operation time （34.3 ± 16.1 vs 38.5±19.3）mins, were not significant difference （ P〉0.05）; the rate of complication 27% （12/43）, 12.5 % （5/40） were significant difference（P〈0.01） ; the adverse reaction rate of intravesical chemotherapy 18/43 （41.9%）,15/40（37.5%） were not significant difference （ P〉0.05）; and recurrence rate 23.2%（10/43） and 27.5 % （11/40） were not significant difference （ P〉 0.05 ）. Conclusions： Therapeutic equivalence was observed in superficial bladder tumor therapy comparison between TuRBT and HLABT. The operative time, the incidence of side effects and the secondary tumor recurrence after chemotherapy infusion were not significant difference, and tumor stage and grade is still the major factor in the prognosis of superficial bladder cancer. The difference of post operative complications was come from obturator nerve reflex.