BT-ESD与TURBT治疗浅表性膀胱肿瘤疗效对比研究

发布时间：2018-05-12 23:29

本文选题：非肌层浸润性膀胱癌(NMIBC) + 经尿道膀胱肿瘤内镜黏膜下剥离术(BT-ESD)　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:比较利用海博刀行经尿道膀胱肿瘤内镜下黏膜下剥离术(BT-ESD)与经尿道膀胱肿瘤电切术(TURBT)治疗浅表性膀胱肿瘤的疗效,探索BT-ESD治疗浅表性膀胱肿瘤的安全可行性及有效性,评价BT-ESD的临床应用价值。方法:收集并分析我院2015年01月至2016年12月期间54例浅表性膀胱肿瘤患者临床资料,24例患者经BT-ESD治疗,30例经TURBT治疗,记录手术时间、膀胱持续冲洗时间、出血情况、膀胱穿孔、闭孔神经反射等相关并发症、导尿管留置时间、术后住院时间及随访术后1年内复发状况。术后定期膀胱灌注化疗。结果:两治疗组手术均顺利完成。BT-ESD组24例患者切除独立病灶31处,直径为10-40mm,28个肿瘤完整取出,3个切碎取出;BT-ESD组手术时间(73.33±34.06)min与TURBT组(52±39.73)min相比,差异有统计学意义(P0.05);BT-ESD组膀胱冲洗时间(0.667±0.817)d,TURBT组(1.33±0.99)d,差异有统计学意义(P0.05);BT-ESD组导尿管留置时间(3.375±1.24)d少于TURBT组(5.40±1.99)d,差异有统计学意义(P0.05);BT-ESD术后住院时间少于TURBT组,差异有统计学意义(P=0.001);BT-ESD组有1例出血,无其他并发症;TURBT组闭孔神经反射7例,膀胱穿孔2例,出血5例,术后住院时间7天11例,总共11位患者发生并发症。两组间总的并发症发生率有统计学意义(P0.05);其中BT-ESD组闭孔神经反射、术后住院时间大于7天的发生率与TURBT相比,差异有统计学意义(P0.05);两组间的膀胱穿孔、出血方面,差异无统计学意义(P0.05)。BT-ESD组15例随访12个月,尚未见复发。TURBT组19例患者经12个月随访,6例患者复发,复发率为31.58%(6/19),差异有统计学意义(P0.05)。结论:1.BT-ESD作为浅表性膀胱癌的腔内微创治疗是安全可行有效的;2.BT-ESD完整切除的肿瘤组织标本保存完好,使病理医师更加精确了肿瘤分期分级,对后续治疗、预后判断有重要的临床意义;3.BT-ESD与TURBT相比可明显减少手术并发症,提高手术效果,缩短了术后恢复时间;4.短期随访BT-ESD可显著有效降低患者术后肿瘤复发率。
[Abstract]:Objective: to compare the efficacy of transurethral endoscopic submucosal dissection of bladder tumor (BT-ESD) and transurethral resection of bladder tumor (TURBT) in the treatment of superficial bladder tumor with Haibo knife, and to explore the safety and efficacy of BT-ESD in the treatment of superficial bladder tumor. To evaluate the clinical value of BT-ESD. Methods: the clinical data of 54 patients with superficial bladder tumor from January 2015 to December 2016 were collected and analyzed. 24 patients were treated with BT-ESD and 30 patients were treated with TURBT. The time of operation, the duration of bladder irrigation, bleeding and bladder perforation were recorded. Related complications such as obturator nerve reflex, catheter indwelling time, postoperative hospitalization time and recurrence status within 1 year follow up. Postoperative intravesical chemotherapy was performed regularly. Results: the operation time of BT-ESD group was 73.33 卤34.06)min and that of BT-ESD group was 73.33 卤39.73)min compared with that of TURBT group, the diameter was 10-40mm, 28 tumors were removed completely, and the operation time of BT-ESD group was 73.33 卤39.73)min. There was significant difference in bladder irrigation time (0.667 卤0.817 d) and urinary catheter indwelling time (3.375 卤1.24 days) in BT-ESD group (P 0.05 卤0.99 d), and the hospitalization time after BT-ESD operation in TURBT group was significantly less than that in TURBT group (P 0.05 卤1.99 d). There was no significant difference in the duration of bladder irrigation between BT-ESD group and BT-ESD group (P 0.05 卤0.817 d), and the time of indwelling urethral catheter in BT-ESD group was less than that in TURBT group (P 0.05 卤1.24 d, P < 0.05 卤1.99 d). The difference was statistically significant in BT-ESD group (P < 0.001). There were 1 case of hemorrhage, 7 cases of obturator nerve reflex, 2 cases of bladder perforation and 5 cases of hemorrhage in TURBT group. The postoperative hospitalization time was 7 days in 11 cases. The incidence of complications in BT-ESD group was significantly higher than that in TURBT group (P 0.05), the incidence of obturator nerve reflex in BT-ESD group was longer than 7 days after operation, and there was significant difference between the two groups in the incidence of bladder perforation and hemorrhage. No significant difference was found in 15 patients in the P0.05U. BT-ESD group for 12 months, 19 patients in the TURBT group were followed up for 12 months, and the recurrence rate was 31.58 / 19. The difference was statistically significant (P 0.05). Conclusion: 1. BT-ESD is a safe, effective and safe minimally invasive treatment for superficial bladder cancer. 2. The intact specimens of BT-ESD have been preserved well, which makes the pathologist more accurate in staging and grading of the tumor and in the follow-up treatment. 3. BT-ESD can significantly reduce the complications, improve the effect and shorten the time of postoperative recovery compared with TURBT. 3. Short-term follow-up BT-ESD can significantly reduce the recurrence rate of postoperative tumor.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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