目的 探讨等离子针状电极剜切术治疗非肌层浸润性膀胱癌的技术特点及应用.方法 选择经膀胱镜病理检查确诊的初发非肌层浸润性膀胱癌38例,在全身麻醉或者连续硬膜外麻醉下行等离子针状电极整块剜除术,术中剜除肿瘤后在膀胱内注入无菌蒸馏水200 mL,保留膀胱灌注30 min,留置尿管.术后行膀胱灌注规范化疗,观察手术剜切时间、出血量、术中闭孔神经反射发生情况以及术后尿管留置时间及并发症发生、术后复发等情况.结果 本组男31例,女7例,年龄26～78岁;肿瘤直径0.5～3.0 cm,肿瘤数目1～3个.所有患者均手术剜切术成功,手术时间5～45 min,术中出血量轻微,发生闭孔反射3例,无膀胱穿孔发生,术后尿管留置时间2～5 d;5例多发肿瘤患者,术后4～6周再次行剜除术.随访3～24个月,4例出现异位复发.结论 等离子针状电极剜切术治疗非肌层浸润性膀胱癌整块切除,简单、安全、并发症少、疗效满意、设备门槛低、便于基层医院开展.%Objective To explore the technical characteristics and applications of pin-shaped plasmakinetic electrode in the transurethral resection of non-muscle invasive bladder carcinoma.Methods A total of 38 pathologically confirmed nonmuscular invasion bladder cancer patients received operation under general or epidural anesthesia.After the tumor was removed,200 mL sterile distilled water was infused into the bladder,kept for 30 min,and then urethral catheterization was indwelt.All patients underwent regular urinary bladder irrigation chemotherapy.The operation time,blood loss,postoperative urine tube indwelling time and complications were observed.Results The patients included 31 males and 7 females,aged 26-78 years.The tumor diameter ranged 0.5-3.0 cm,and the tumor number ranged 1-3.All operations were successful.The operation time was 5-45 min,with slight bleeding during operation.Obturator nerve reflex was observed in 3 cases,but no bladder perforation occurred.The urethral catheterization time was 2-5 days.For the 5 patients who had more than 1 tumor,a second operation was conducted 4-6 weeks later.During the follow-up of 3-24 months,relapses occurred in 4 cases.Conclusion Pin-shaped plasmakinetic electrode surgery is safe,effective and cheap for non-muscular invasion bladder cancer,which causes few complications but produces favorable prognosis.It's applicable in basic-level hospitals.
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