天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (9): 976-980.doi: 10.11958/20170420

• 临床研究 • 上一篇    下一篇

绿激光汽化术治疗膀胱肿瘤 522 例临床观察

张志华，陈雅童，李昭夷，张廷继，冯起庆，李健△   

  1. 天津市人民医院泌尿外科（邮编 300121）
  • 收稿日期:2017-04-06 修回日期:2017-08-13 出版日期:2017-09-15 发布日期:2017-09-25
  • 通讯作者: 张志华 E-mail:dzh_0204@163.com

Clinical observation of green laser vaporization for the treatment of bladder tumor in 522 patients

ZHANG Zhi-hua, CHEN Ya-tong, LI Zhao-yi, ZHANG Ting-ji, FENG Qi-qing, LI Jian△   

  • Received:2017-04-06 Revised:2017-08-13 Published:2017-09-15 Online:2017-09-25

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摘要： 摘要：目的 探讨经尿道膀胱肿瘤绿激光汽化术（PVBT）治疗膀胱尿路上皮癌的疗效及安全性。方法 2010 年 1 月—2015 年 5 月期间，共收治膀胱尿路上皮癌患者 522 例，其中非肌层浸润性膀胱癌（NMIBC）405 例，肌层浸润性 膀胱癌（MIBC）117 例。均采用 PVBT 治疗，术后膀胱灌注表柔比星，其中 MIBC 患者联合术后静脉化疗（吉西他滨+ 顺铂）。结果 NMIBC 组住院时间（7.32±1.28）d，手术时间（27.08±5.36）min，留置尿管时间（2.42±0.34）d，术后随访 12~60 个月，复发 38 例（9.4％），其中 3 例行根治性膀胱切除术，余 35 例再次行 PVBT；405 例患者全部存活。MIBC 组住院时间（26.18±1.92）d，手术时间（38.32±6.54）min，留置尿管时间（2.72±0.85）d，术后随访 12~60 个月，复发 19 例 （16.2％），4 例患者行根治性膀胱切除术，余 15 例再次行 PVBT；复发者中有 6 例死于膀胱癌远处转移（2 例肺转移，4 例骨转移），余 111 例存活。结论 PVBT 是安全、有效的手术方式，尤其适用于 NMIBC 及不能或不愿行根治性膀胱 切除术的 MIBC 患者。

关键词: 膀胱肿瘤, 尿路上皮癌, 激光治疗, 绿激光汽化术, 复发, 随访

Abstract: Objective To investigate the safety and efficacy of photoselective greenlight vaporization of bladder tumor (PVBT). Methods A total of 522 patients of bladder cancer were enrolled in present study from January 2010 to May 2015, includ 405 cases of non muscle-invasive bladder cancer (NMIBC) and 117 cases of muscle-invasive bladder cancer(MIBC). They had been treated by PVBT with intravesical instillation of epirubicin and the patients in MIBC received intravenous chemotherapy (kisi-hama and cisplatin). Results All of the patients were treated by PVBT under spinal anesthesia or general anesthesia. The average hospitalization time of patients in NMIBC group was (7.32±1.28) days, the average operation time was (27.08±5.36) min, and the average time of indwelling urinary catheter was (2.42±0.34) days. During the follow-up period (12-60 months), 38 cases (9.4%) relapsed, of which 3 cases underwent radical cystectomy, and other 35 cases underwent PVBT again. All 405 patients were alive at the end of follow up. The average hospitalization time of MIBC patients was (26.18±1.92) days, the average operation time was (38.32±6.54) min, and the average time of indwelling urinary catheter was (2.72±0.85) days. During the follow-up period (12-60 months), 19 cases (16.2%) relapsed. Among them, 4 patients underwent radical cystectomy, and other 15 cases underwent PVBT. Six patients died from distant organ metastasis (including 2 cases of pulmonary metastasis and 4 cases of bone metastasis), and other 111 patients survived. Conclusion PVBT is safe and effective in the treatment of bladder tumor, especially for NMIBC and MIBC patients who are unable or unwilling to undergo radical cystectomy.

Key words: bladder tumor, urothelial carcinoma, laser therapy, greenlight vaporization, recurrence, follow up