南昌大学第二附属医院 泌尿外科，江西 南昌 330006
Department of Urology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
目的 比较经尿道膀胱肿瘤铥激光整块剜除术（ThuLEBT）与等离子整块剜除术（TeURBT）治疗浅表性膀胱肿瘤的临床疗效。方法 选取2018年9月—2020年9月收治的病理诊断为浅表性膀胱肿瘤的患者225例，分为ThuLEBT组（n = 107）和TeURBT组（n = 118），ThuLEBT组行ThuLEBT，TeURBT组行TeURBT。观察两组患者手术时间、术中闭孔神经反射发生率、术后血尿持续时间、留置导尿时间、膀胱刺激征发生率、术后住院时间和术后病理标本肌层发现率。术后随访1年，定期规律行膀胱灌注化疗及膀胱镜检查，记录肿瘤复发情况。结果 两组患者均顺利完成手术，两组患者手术时间比较，差异无统计学意义（P > 0.05）；ThuLEBT组术中出血量少于TeURBT组，术后出血时间、导尿管留置时间和术后住院时间短于TeURBT组，差异均有统计学意义（P < 0.05）；ThuLEBT组术中闭孔神经反射发生率、术后膀胱刺激征发生率和随访1年复发率低于TeURBT组，差异均有统计学意义（P < 0.05）；ThuLEBT组术后病理检测膀胱肌层包含率明显高于TeURBT组，差异有统计学意义（P < 0.05）。结论 ThuLEBT应用于非肌层浸润性膀胱肿瘤手术，治疗效果确切，患者获益明显，值得临床进一步推广应用。
Objective To compare the clinical efficacy of the thulium laser en-bloc enucleation of bladder tumor (ThuLEBT) and the plasma transurethral en-bloc enucleation of bladder tumor (TeURBT) in treatment of superficial bladder cancer.Methods 225 patients pathologically identified with non-muscle-invasive bladder cancer were enrolled from September 2018 to September 2020, divided into ThuLEBT group (n = 107) and TeURBT group (n = 118), ThuLEBT group underwent ThuLEBT and TeURBT group underwent TeURBT. The operation time, the incidence of intraoperative obturator nerve reflex, duration of postoperative hematuria, indwelling catheter time, the incidence of bladder irritation, postoperative hospitalization time, and bladder muscle layer was observed in the two groups. After 1 year of postoperative follow-up, gemcitabine intravesical chemotherapy and cystoscopy were performed regularly to record tumor recurrence.Results The two groups of patients have completed the operation, the operation time show no differences between the two groups (P > 0.05); The intraoperative blood loss in the ThuLEBT group was less than that in TeURBT group, postoperative bleeding time, indwelling catheterization time, and postoperative hospitalization time in the ThuLEBT group were shorter than those in TeURBT group, and the differences were statistically significant (P < 0.05); The incidence rate of intraoperative obturator reflex, the incidence of bladder irritation and recurrence rate after 1-year follow-up in ThuLEBT group were lower than those in TeURBT group (P < 0.05); The bladder muscle layer of postoperative pathological examination specimens in ThuLEBT group was significantly higher than that in TeURBT group (P < 0.05).Conclusion ThuLEBT is effective in treatment of non-muscle-invasive bladder cancer, with obvious benefits. It is worthy of being widely popularized in clinical application.