经尿道铥激光膀胱肿瘤整块切除术临床疗效分析

目的探讨经尿道铥激光膀胱肿瘤整块切除术的手术技巧及其临床应用价值。方法回顾性分析2016年10月至2019年9月芜湖市第二人民医院收治的74例浅表性膀胱肿瘤患者的临床资料，其中37例行经尿道铥激光膀胱肿瘤整块切除术 (Thu ERBT)者为Thu ERBT组，37例行经尿道膀胱肿瘤等离子电切术（PKRBT）者为PKRBT组。对比两组手术时间、住院时间、手术并发症发生率、肿瘤复发率以及病理检查结果。结果所有手术均成功完成。Thu ERBT组术中无闭孔神经反射和膀胱穿孔发生；PKRBT组有9例发生闭孔神经反射现象，其中4例导致膀胱穿孔。两组在留置尿管时间、并发症发生率和术后病理有无肌层组织上差异有统计学意义(P＜005)，两组患者在手术时间、住院时间、复发率和术后病理级别上差异无统计学意义(P＞005)。结论Thu ERBT术具有精确切割、瘤体标本完整、无闭孔神经反射、病理分期准确等优点，可以作为治疗浅表膀胱肿瘤有效的方法让患者从中获益。

Discussion of clinical benefit and operation skill of transurethral thulium laser Enbloc resection of bladder tumor

Objective: To investigate the surgical technique and clinical value of transurethral thulium laser Enbloc resection of bladder tumor. Methods: The clinical data of 74 patients with superficial bladder tumors treated in Wuhu Second People's Hospital from October 2016 to September 2019 were analyzed retrospectively. 37 patients underwent transurethral thulium laser Enbloc resection of bladder tumor (Thu-ERBT) as the experimental group and 37 patients underwent transurethral plasma resection of bladder tumor (PKRBT) as the control group. The operation time, hospital stay, incidence of surgical complications, recurrence rate and pathological findings were compared between the two groups. Results: All operations were successfully completed. There was no obturator nerve reflex and bladder perforation in Thu-ERBT group. Obturator nerve reflex occurred in 9 cases in PKRBT group, of which 4 cases resulted in bladder perforation. There was significant difference between the two groups in the indwelling catheter time ,incidence of complications and the presence or absence of muscle tissue in postoperative pathology (P < 0.05). There was no significant difference in operation time, hospital stay, recurrence rate and postoperative pathological grade between the two groups (P > 0.05). Conclusion: Thu-ERBT has the advantages of accurate cutting, reserve complete tumor specimens, no obturator nerve reflex and accurate pathological staging. It can benefit patients as an effective method for the treatment of superficial bladder tumors.