输尿管口旁浅表性膀胱肿瘤的微创治疗

目的：总结输尿管口旁浅表性膀胱肿瘤微创治疗的临床经验。方法：在连续硬脊膜外麻醉＋患侧闭孔神经阻滞麻醉下行内腔镜手术治疗输尿管口旁浅表性膀胱肿瘤患者25例，其中2l例肿瘤位于输尿管口周围2．0cm以内，但未累及输尿管口；4例肿瘤基底位于输尿管口内。经尿道先置人70。膀胱镜了解肿瘤具体情况，然后更换电切镜，从基底部将肿瘤及包括输尿管口在内的周围2cm正常膀胱黏膜快速一并完整切除。结果：25例手术均顺利结束，无出血、穿孔等并发症。25例均获得随访，时间为12～24个月，无输尿管口狭窄、闭锁、严重的膀胱输尿管反流、肾功能受损等并发症发生。结论：经尿道微创手术治疗输尿管口旁浅表性膀胱肿瘤，操作简单，创伤小，可代替开放性手术。

Minimally invasive treatment for superficial bladder tumor near ureteral orifice

Objective：To evaluate the minimally invasive treatment for superficial bladder cancer near ureteral orifice. Method：Under continuous epidural anethesia adding affected side obturator nerve block, 25 patients with superfieal bladder tumors next to the ureteral orifices were treated by endoscopic surgery. Among 21 cases, the tumors were located around the urethral orifices, within 2.0 em or less, but not involving the ureteral orifices. For 4 cases, the bases of tumors were in the orifices. Firstly, place 70~ cystoscope by transurethral to watch the specific situation of tumors, and then replace the resectoscope. Lastly, reseet the tumors together with the ureteral orifices, induding normal bladder mucosa around 2 cm of the orifices from the bases, quickly and completely. Result： Twenty-five operations were performed smoothly, no bleeding, perforation and other complications. All the patients were followed up. The time was between 12 months and 24 months. No stenosis and atresia of ureteral orifice, serious vesico ureteral reflux, or renal function damage happened. Conclusion： Minimally invasive management of superficial bladder tumor around ureteral orifice is better with technically easier, smaller trauma, more reliable efficacy and can replace open surgery.