经尿道2μm激光膀胱部分切除治疗膀胱肿瘤疗效分析

发布时间：2018-03-20 09:05

本文选题：膀胱肿瘤　切入点：2μm激光　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：建立经尿道2μm激光膀胱部分切除术治疗膀胱肿瘤新术式、分析应用此方法治疗膀胱肿瘤的临床特点；分析此方法所获标本的病理组织学特点、观察肿瘤病理分期,随诊观察2μm激光手术对膀胱壁组织形态学的影响、总结分析膀胱肿瘤患者术后的随诊特点。方法：在2011年5月至2013年7月间,通过术前检查,选取我科住院的膀胱尿路上皮癌患者,采用经尿道2μm激光膀胱部分切除术进行治疗。分析手术特点,观察临床疗效；对所获得标本进行病理切片分析；总结患者随诊结果,分析膀胱肿瘤患者术后的随诊特点。结果：所有患者在静脉复合或椎管麻醉下均可耐受经尿道2gm激光膀胱部分切除术。手术时间8～45分钟,术中几乎不出血,无闭孔神经反射,术后亦无继发出血；切除瘤体的组织病理学分析证实：该方法可将瘤体及其附着的膀胱粘膜、粘膜下层及全部肌层完整切除,切缘无癌细胞残留；术后随访3-15个月,无原位复发。本组尿路上皮癌患者随访近1年生存率100%,生活质量较好,随诊配合率高。结论：(1)经尿道2μm激光膀胱部分切除术治疗膀胱肿瘤是一种安全有效的新方法。由于2μm激光可以做到对膀胱壁全层精细的分层解剖,手术可以在肌层与外层疏松结缔组织之间进行剥离,因此可以达到膀胱部分切除的目的。2μm激光膀胱部分切除术不仅可以有效地治疗侵及粘膜固有层的非肌层浸润性肿瘤,也可以治疗侵及局部肌层的浸润性肿瘤。这样可能为治疗部分浸润性膀胱肿瘤开辟了新途径。(2)经尿道2gm激光膀胱部分切除术所获得的标本,肿瘤及其附着的膀胱壁全层组织完整,可准确判定肿瘤的临床分期,有效地指导后续治疗,术后创面恢复良好。(3)采用经尿道2μm激光膀胱部分切除术,对肿瘤组织的破坏较少,可以保持瘤体的完整性。(4)应用经尿道2μm激光膀胱部分切除术,对于治疗非浸润性膀胱肿瘤和浸润性膀胱肿瘤都是有意义的：对非浸润性膀胱肿瘤患者,手术安全可靠,疗效明确,可以很好的制定患者个性化治疗方案,减少不必要的手术并发症。对于浸润性膀胱肿瘤患者术后疗效满意,生活质量较好,患者选择保留膀胱及正常排尿功能的意愿得到尊重。
[Abstract]:Objective: to establish a new method of transurethral partial cystectomy with 2 渭 m laser for the treatment of bladder tumor, to analyze the clinical features of this method, to analyze the histopathological characteristics of the specimens obtained by this method, and to observe the pathological stages of the tumor. To observe the effect of 2 渭 m laser surgery on bladder wall histomorphology, and to summarize and analyze the characteristics of postoperative follow-up of bladder tumor patients. Methods: from May 2011 to July 2013, the patients with bladder urothelial carcinoma in our department were selected and treated by transurethral 2 渭 m laser cystectomy. The pathological sections of the specimens were analyzed, and the results of follow-up were summarized, and the characteristics of postoperative follow-up of bladder tumor patients were analyzed. Results: transurethral partial cystectomy with 2gm laser was tolerated in all patients under intravenous or spinal anaesthesia. The operative time was 845 minutes. There was almost no bleeding, no obturator nerve reflex and no secondary bleeding after operation. Histopathological analysis showed that the tumor and its adherent bladder mucosa, submucosa and all myometrium could be removed completely, and no cancer cells remained in the incised margin. In this group of patients with urothelial carcinoma, the 1 year survival rate was 100%, the quality of life was better and the cooperation rate of follow-up was high. Conclusion transurethral partial cystectomy with 2 渭 m laser is a safe and effective method for the treatment of bladder tumors. Surgery can be performed between the muscular layer and the outer loose connective tissue, so that the partial cystectomy can be achieved. 2 渭 m laser partial cystectomy can not only effectively treat non-myometrial infiltrating tumors involving the lamina propria of the mucous membrane. This may open up a new approach to the treatment of partially invasive bladder tumors, and may open up a new approach to the treatment of partial cystectomy by transurethral 2gm laser cystectomy. The complete tissue of the tumor and its attached bladder wall can accurately determine the clinical stage of the tumor and guide the follow-up treatment effectively. The wounds recovered well after operation. The partial cystectomy with transurethral 2 渭 m laser can do little damage to the tumor tissue. Partial cystectomy with transurethral 2 渭 m laser is of significance in the treatment of both non-invasive bladder tumors and invasive bladder neoplasms: it is safe and reliable for patients with non-invasive bladder tumors. The curative effect is clear, can make the patient individuation treatment plan very well, reduce unnecessary operation complication, the curative effect is satisfied for the patient with invasive bladder tumor, the quality of life is better, The patient's willingness to choose to retain bladder and normal urination function was respected.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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