摘要
目的应用绿激光治疗浅表性膀胱肿瘤31例,研究术后基底部病理情况,评估绿激光汽化切除浅表性膀胱肿瘤的可靠性、安全性、疗效和彻底性。方法 2010年3月至2010年10月,应用国产瑞尔通100W绿激光,经尿道治疗浅表性膀胱肿瘤患者31例,其中男性患者24例,女性患者7例,年龄37～80岁(平均67岁),16例患者患有不同程度的心肺脑疾病。所有病例术前均经CT检查和膀胱镜取活检,病理为浅表性肿瘤,病理分级G1～G2,分期Ta～T1。肿瘤单发24例,多发7例,肿瘤直径0.3～3.5cm。并在行绿激光汽化肿瘤后,取肿瘤基底部活检并送病理。手术采用腰硬联合麻醉,每个肿瘤均汽化至见到膀胱壁呈网格结构。结果本组31例患者均取得手术成功。手术时间10～40min,平均20min,术中无明显出血,无闭孔神经反射、膀胱穿孔及术后继发性大出血等并发症。31例患者肿瘤汽化切除后基底部病理均未查见肿瘤细胞。术后留置导尿管1～3天,无1例需行膀胱冲洗,术后定期行丝裂霉素、吡柔比星或BCG等药物膀胱灌注。术后所有病例均定期随访,定期行膀胱镜检查(第1年每3个月1次,后根据肿瘤复发情况调整检查间隔),随访6～12个月,平均9个月,肿瘤复发2例,均为异位复发,复发率为6.5%。结论绿激光治疗浅表性膀胱肿瘤疗效确切,其汽化切除深度可达膀胱壁深肌层甚至到包膜,可将所见肿瘤彻底汽化切除。同时绿激光治疗浅表性膀胱肿瘤具有操作简单,安全性高,术后并发症少等优点,伴有心肺脑疾病的老年患者同样适用。
Objective To evaluate the reliability,safety,efficacy and thoroughness of green laser in the treatment of superficial bladder tumor.Methods A total of 31 patients,including 24 male and 7 female patients,aged 37 to 80(average 67),with superficial bladder tumor underwent 100W green laser vaporization from March 2010 to October 2010,single tumor in 24 cases and multiple tumors in 7 cases.The diameter of the tumor was 0.3～3.5 cm,with the pathology stage Ta～T1 and grade G1～G2 by cystoscopic biopsy before the surgery.Biopsies of the surgical basement were performed in the 31 cases.Results All patients underwent operations successfully,with the operation time 10～40min(average 20min),and no obturator jerk,bladder perforation or secondary hemorrhage occurred.According to the pathology results,in the 31 cases,none of the speciments grabbed from the surgical basement contained residual malignant tissue.The catheters were removed 1 to 3 days after the operations and no bladder washing was necessary.The patients were followed up for 6 to 12 months(average 9 months),with 2 cases of ectopic recurrence and no in-field recurrence.Conclusions Green laser vaporization in the treatment of bladder tumors,which can ablate the entire tumor deeply enough,is an effective,safe andminimally invasive method with less complications,especially suitable for those of advanced age or at high risk.
出处
《泌尿外科杂志（电子版）》
2011年第2期27-30,17,共5页
Journal of Urology for Clinicians(Electronic Version)
关键词
绿激光
基底部病理
膀胱肿瘤
疗效
Green laser
Biopsy of the surgical basement
Bladder tumor
Therapic effect
