钬激光在膀胱肿瘤中的临床应用

目的探讨钬激光腔内治疗膀胱肿瘤的可行性与疗效。方法对150例膀胱肿瘤患者，其中58例广泛多发性原位膀胱肿瘤及16例（T2期13例，T3期3例）要求保留膀胱的膀胱癌患者施行经尿道钬激光肿瘤切除术。对随访发现复发者，再次或多次行钬激光腔内治疗。结果150例患者成功实施钬激光切除肿瘤183台次。术后并发症有膀胱出血（12例）、创面延迟愈合（8例）。术后随访2～3a，1a内复发18例，死亡3例，2a生存率为96％。患者心理状态良好，生活基本自理，具备正常社会活动能力，生活质量自我评价良好。结论钬激光手术治疗膀胱肿瘤微创安全，效果良好，保留膀胱钬激光腔内治疗膀胱癌对患者术后生活质量影响甚微，符合循证医学原则，须严格把握肿瘤性质及分期分级等手术适应证。

Clinic application of Holmium Laser in Bladder Cancer

Objective To assess the feasibility and efficency of transurethral resection with holmium laser for bladder tumor. Methods All the patient especially including 74 cases of bladder cancer with 58 patients of poly-bladder canc- er and 16 patient of invasive bladder tumor （13 T2,3 T3） who didnot accept cystectomy were treated by transure- thral holmium laser （100W） resection. The same procedure was performed repeatedly if tumor recurrence was found. Results Transurethral holmium laser （ 100 W} resection was successful for 150 cases. Tumor recurrence oc- curred in 18 cases （24~） during 12 months post-operation, and 3 cases died of tumor progression. Follow-up from at least 24 months to 3 years showed that the patients had good psychological condition, normal daily life and social activity, and well quality of life. Conclusion Transurethral resection with holmium laser for bladder cancer showed minimally invasive, safe and good efficient. Transurethral holmium laser resection combined with bladder preserva- tion for bladder tumor has mini-mal influences on the patient＇s quality of life. It accords with the principle of evi- dence-based medicine. But the tumors nature, stage, grade and indications should be handled strictly.