TURBT与ESD-HOLBT治疗NMIBC的对比研究

发布时间：2018-04-10 09:44

本文选题：经尿道膀胱肿瘤电切术　切入点：内镜粘膜下剥离术　出处：《山东大学》2017年硕士论文

【摘要】：[目的]比较分析经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)与经尿道膀胱黏膜剥离联合钬激光膀胱肿瘤切除术(endoscopic submucosal dissection combined holmium laser resection of bladder tumor,ESD-HOLRBT)两种手术方法在治疗非肌层浸润性膀腕肿瘤(non muscle-invasive bladder cancer,NMIBC)中临床效果的安全性和有效性以及预后情况,探讨未来非肌层浸润性膀胱肿瘤治疗的新方向。[方法]本研究采取回顾性分析的方法,严格遵循病例入选和排除标准,选取山东大学附属省立医院保健泌尿外科自2015年1月至2016年6月期间收治的非肌层浸润性膀胱肿瘤患者共94例。录入患者的基本信息及临床资料,并进行统计分析。根据患者的症状、体征、病史、术前相关辅助检查等,正确判断手术指征,合理评估手术风险,分别行TURBT和ESD-HOLRBT,以此分为TUR]BT手术组(A组,51例)和ESD-HOLRBT手术组(B组,43例)。针对两组从手术时间、膀胱冲洗时间、留置导尿管时间、住院时间;闭孔神经反射、电切综合征、膀胱穿孔、尿路感染发生率;术后3个月、6个月及12个月复发情况等反应两种手术的有效性、安全性及预后的相关指标进行对照分析。应用SPSS 20.0软件进行数据的录入、统计、分析。两组间定性数据采取卡方检验,定量数据资料以X、S表示,采取t检验,P0.05为差异有统计学意义。[结果]所有94例患者均一次性成功完成手术。TURBT与ESD-HOLRBT两组间年龄、性别、有无肉眼血尿、肿瘤数量、肿瘤直径等一般信息均无明显统计学差异(P0.05),具有可比性。反应手术有效性的指标方面,两组手术时间、膀胱冲洗时间、留置导尿管时间、住院时间相比有明显的差异(P0.05)。TURBT组仅在手术时间上优于ESD-HOLRBT组,其余指标均表明ESD-HOLRBT组更胜一筹。反应手术安全性及预后的指标方面,两组发生闭孔神经反射、电切综合征、膀胱穿孔、大出血、尿路感染以及术3个月、6个月、12个月肿瘤复发率,ESD-HOLRBT较TURBT组占有明显优势。[结论]1、ESD-HOLRBT具有术中失血极少,术野清晰,不发生闭孔神经反射、膀胱穿孔及电切综合征,术后留置尿管时间短,下床活动恢复快,患者遭受痛苦小的优点。2、ESD-HOLRBT方便切除特殊部位肿瘤,切割精准,几乎无残留,病理标本完整,可精确判断分级、分期,正确指导术后治疗,极大降低了复发率。3、ESD-HOLRBT适应证广泛,操作简便、过程安全、疗效显著、复发率低。可作为治疗NMIBC的理想手术方式,值得推广。
[Abstract]:[objective] to compare transurethral resection of bladder tumor transurethral resection with transurethral bladder mucosal dissection and holmium: YAG laser submucosal dissection combined holmium laser resection of bladder tumor of bladder tumor ESD-HOLRBT in the treatment of non-myometrial infiltration.Clinical efficacy, safety and prognosis of patients with muscle-invasive bladder cancer of the wrist.To explore the new direction of non-myometrial invasive bladder tumor treatment in the future.[methods] the method of retrospective analysis was adopted in this study, and the criteria of case selection and exclusion were strictly followed.From January 2015 to June 2016, 94 patients with non-myometrial invasive bladder tumor were treated in the Department of Urology, affiliated Provincial Hospital of Shandong University.Input the patient's basic information and clinical data, and carry on the statistical analysis.According to the symptoms, signs, medical history, preoperative auxiliary examination and so on, the indication of operation was correctly judged and the operation risk was reasonably evaluated. The patients were divided into two groups: TURBT and ESD-HOLRBT (51 cases in group A) and 43 cases in group B (ESD-HOLRBT group).The incidence of obturator nerve reflex, electrocution syndrome, bladder perforation, urinary tract infection was observed in two groups, including operation time, bladder irrigation time, indwelling catheter time, hospital stay time, obturator nerve reflex, electrosurgical syndrome, bladder perforation and urinary tract infection.The efficacy, safety and prognosis of the two kinds of operations were compared and analyzed in 3 months, 6 months and 12 months after operation.The qualitative data of the two groups were chi-square test, the quantitative data were expressed as Xs, and the difference between the two groups was statistically significant by using t test (P0.05).[results] there was no significant difference in age, sex, gross hematuria, tumor number and tumor diameter between the two groups (P 0.05).The operative time, bladder irrigation time, indwelling catheter time and hospitalization time of the two groups were significantly different. The operation time of the two groups was only better than that of the ESD-HOLRBT group. The other indexes indicated that the ESD-HOLRBT group was better than the ESD-HOLRBT group.In terms of the safety and prognosis of surgery, the incidence of obturator nerve reflex, electrocution syndrome, bladder perforation, massive hemorrhage, urinary tract infection and tumor recurrence rate were significantly higher in the two groups than in the TURBT group at 3 months, 6 months and 12 months.[conclusion] 1ESD-HOLRBT has less blood loss during operation, clear operative field, no obturator nerve reflex, bladder perforation and electrocution syndrome, short indwelling time after operation, and quick recovery of bed movement.The procedure is simple, safe, effective and low recurrence rate.It can be used as an ideal surgical method for NMIBC, and it is worth popularizing.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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