不同介质介导膀胱肿瘤电切术在膀胱肿瘤治疗中的对比研究

摘要

目的 对比研究 CO2介导经尿道膀胱肿瘤电切术(TURBT)与传统水介导 TURBT对膀胱肿瘤的治疗作用.方法 52例膀胱肿瘤患者随机分为 A、B两组,A组(28例):以 CO2气体为介质行TURBT;B组(24例):行传统 TURBT,观察比较两组的手术时间、术中出血量、用水量、术中及术后并发症、术后住院天数、肿瘤复发率等.结果 A组患者平均手术时间17(8~35)min、术中微量出血(未精确计算)、术中平均用水量807.7(500~1000)ml、术中及术后无并发症发生、术后平均住院时间为5(4~7)d.术后病理:尿路上皮细胞癌26例,乳头状肿瘤2例.随访12~36个月,肿瘤复发3例.B组患者平均手术时间20(15~40)min、术中少量出血(未精确计算)、术中平均用水量13500(6000~18000)ml、术中1例因闭孔神经反射发生膀胱穿孔(轻微,未更改手术方案)、术后无并发症发生、术后平均住院时间为5.2(4~10)d.术后病理:尿路上皮细胞癌22例,乳头状肿瘤1例,低度恶性倾向尿路上皮乳头状肿瘤1例.随访12~36个月,肿瘤复发2例.结论与传统TURBT相比,CO2为介质的TURBT在手术时间、并发症、住院天数等方面无明显优势,但视野清晰,用水量少,可作为非肌层浸润性膀胱肿瘤的一种新的治疗方法进行推广.%Objective To compare the value between CO2mediated transurethral resection of bladder tumor technique and conventional transurethral resection of bladder tumor technique in treat-ment of bladder tumor. Methods In total of 52 cases of bladder tumor patients,28 cases under-went CO2mediated transurethral resection of bladder tumor technique (group A),24 cases under-went conventional transurethral resection of bladder tumor technique (group B).We compared the operation time,blood loss,water consumption,hospitalization time,complications and operation effect between two groups. Results In group A,the average operation time was 17 (8-35)min, and there was no obvious bleeding.The average water consumption was 807.7 (500-1 000)ml.There was no complications occurred.The mean postoperative hospital stay was 5 (4-7)days.Postoperative pathology showed 26 cases were urothelial carcinoma and 2 cases were papillary tumor.Three cases recurred during the follow-up period of 12-36 months.In group B,the average operation time was 20 (15-40)min,and there was no obvious bleeding.The average water consumption was 13 500 (6 000-18 000)ml.There was no complications occurred.The mean postoperative hospital stay was 5.2 (4-10)days.Postoperative pathology showed 22 cases were urothelial carcinoma,1 case was papillary tumor,and 1 case was low-grade malignant papillary tumor.Two cases recurred during the follow-up period of 1 2-3 6 months. Conclusions Carbon dioxide pneumovesicum technology for transurethral resection of bladder tumor shows no more advantages in operation time,complications and the mean postoperative hospital stay.But it has a good endoscopic view,no obvious bleeding,less water use and less pollution.It can be used as a new treatment for superficial bladder tumor to spread.