非肌层浸润性膀胱癌2种术式的比较

摘要

目的 探讨非肌层浸润性膀胱癌2种术式的安全性和有效性. 方法 2008年1月~2015年12月100例非肌层浸润性膀胱癌随机分为经尿道钬激光切除术组(HoLRBT组)和经尿道等离子电切术(TURBT组),每组50例,因失访、临床分期和分级变化更改治疗方案、不耐受手术、术后治疗等原因,最终75例进入本研究,其中HoLRBT组37例, TURBT组38例,比较2组手术时间、并发症发生率、术后住院时间及肿瘤复发情况. 结果 HOLRBT、TURBT组手术时间中位数分别为18 min(10~50 min)和20 min(15~45 min),无统计学差异(Z=-1.557,P=0.119);膀胱穿孔发生率[0 vs.10.5%(4/38),Fisher精确检验,P=0.115]、术后低钠血症发生率[0.3%(1/37) vs.18.4%(7/38), xx2=3.351,P=0.067]、术后住院时间[(3.2±0.6) d vs.(3.1±0.5) d,t=0.785,P=0.435]、术后复发率[5.4%(2/37) vs.7.9%(3/38), x2=0.000,P=1.000]均无统计学差异.与TURBT组相比,HoLRBT组闭孔神经反射发生率明显降低[0 vs.26.3%(10/38),Fisher精确检验,P=0.001]. 结论 与传统TURBT相比,HoLRBT治疗非肌层浸润性膀胱癌安全、有效,并发症少,值得临床推广.%Objective To discuss the safety and efficacy of two transurethral resections of bladder tumor in the treatment of non-muscle invasive bladder cancer.Methods A total of 75 patients with non-muscle invasive bladder cancer in our hospital between January 2008 to December 2015 were randomly divided into two groups, transurethral holmium laser resection of bladder tumor group (HoLRBT group, n=37) or transurethral resection of bladder resection (TURBT) group (TURBT group, n=38).The operation time, complication rate, postoperative hospital stay, and tumor recurrence were compared between two groups.Results There was no statistical difference in median operative time [18 min (10-50 min) min vs.20 min (15-45) min, Z=-1.557,P=0.119], bladder perforation [0 vs.10.5%(4/38), Fisher''s exact test, P=0.115], postoperative hyponatremia [0.3% (1/37) vs.18.4% (7/38), x2=3.351, P=0.067], postoperative hospital stay [(3.2±0.6) d vs.(3.1±0.5) d, t=0.785, P=0.435], recurrence rate [5.4% (2/37) vs.7.9% (3/38), x2=0.000, P=1.000] between the two groups.As compared to TURBT group, there was less obturator nerve reflex (0 vs.26.3% (10/38), Fisher''s exact test,P=0.001) in HoLRBT group.Conclusion Compared with curative TURBT, HoLRBT has the characteristics of safety, effectiveness and fewer complications in the treatment of non-muscle invasive bladder cancer, warranting an extensive use clinically.