临床外科杂志 ›› 2022, Vol. 30 ›› Issue (6): 579-582.doi: 10.3969/j.issn.1005-6483.2022.06.022

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激光与电切术治疗非肌层浸润性膀胱癌的疗效及应激反应程度比较

  

  1. 232000 安徽省淮南朝阳医院泌尿外科
  • 收稿日期:2021-10-08 接受日期:2021-10-08 出版日期:2022-06-20 发布日期:2022-06-20

Comparison of effect and stress response between laser resection and electro-resection under cystoscopy for non-muscular invasive bladder cancer

  1. Department of Urology Surgery,Huainan Chaoyang Hospital,Anhui,Huainan 232000,China
  • Received:2021-10-08 Accepted:2021-10-08 Online:2022-06-20 Published:2022-06-20

摘要: 目的 讨膀胱镜下膀胱肿瘤激光切除术与电切术对非肌层浸润性膀胱癌(NMIBC)166例病人的疗效。方法 选取2013年7月~2015年6月我院收治的NMIBC病人作为研究对象,随机平分为激光组和电切组,每组83例。激光组采用膀胱肿瘤激光切除术,电切组采用膀胱肿瘤电切术。比较两组病人术前1天(T0)、术后第1天(T1)、术后3天(T2)、术后7天(T3)氧化应激因子水平、手术指标、术后并发症、以及肿瘤复发率和无瘤生存情况。结果 电切组手术时间为(30.87±3.92)分钟、血尿持续时间(23.56±4.23)小时、尿管留置时间(7.13±1.24)天、术中出血量(27.86±4.35)ml,激光组分别为(23.63±2.78)分钟、(21.16±5.37)小时、(4.97±0.89)天、(20.91±3.21)ml,两组比较差异有统计学意义(P<0.05);术后电切组膀胱穿孔发生率7.23%、闭孔神经反射的发生率9.64%、术后并发症的总发生率为21.10%,激光组分别为0、0、6.02%,两组比较差异有统计学意义(P<0.05);与电切组比较,激光组谷胱甘肽过氧化物酶(GSH-Px)和超氧化物歧化酶(SOD)在T1、T2和T3[GSH-Px:(42.84±2.98)pg/ml、(55.61±3.79)pg/ml、(74.16±5.04)pg/ml;SOD:(97.78±8.24)μmol/L、(122.57±10.03)μmol/L、(154.24±11.34)μmol/L]时均较高,丙二醛(MDA)在T1、T2和T3[(14.33±0.93)mmol/ml、(10.22±0.85)mmol/ml、(5.25±0.57)mmol/ml]时均较低(P<0.05)。术后随访5年,激光组共有10例复发,电切组共有17例复发,两组术后5年总复发率(12.05% vs.20.48%)和累积无瘤生存率比较[(87.95±3.57)% vs(79.52±4.43)%]差异均无统计学意义(P>0.05)。结论  与膀胱肿瘤电切术相比,激光切除术手术时间短、并发症发生率低、应激反应程度轻,具有安全、高效和可靠的效果。

关键词: 膀胱肿瘤, 非肌层浸润性膀胱癌, 激光切除术, 电切术, 应激

Abstract: Objective To investigate the efficacy of cystoscopic laser resection and electric resection of bladder tumor in 166 patients with non muscular invasive bladder cancer (NMIBC).Methods NMIBC patients admitted to our hospital from July 2013 to June 2015 were selected as the research objects,and were randomly divided into laser group and electro-resection group,83 cases in each group.The laser group was treated with laser resection of bladder tumor,and the electro-resection group was treated with electro-resection of bladder tumor.The levels of oxidative stress factors, surgical indicators, postoperative complications, tumor recurrence rate and tumor-free survival were compared between the two groups 1 day before surgery (T0), 1 day after surgery (T1), 3 days after surgery (T2) and 7 days after surgery (T3).Results  After treatment,compared with the electrical group[(30.87±3.92)min,(23.56±4.23)h,(7.13±1.24)(27.86±4.35)ml],the operation time[(23.63±2.78)min],hematuria duration[(21.16±5.37)h] and catheter indwelling time[(4.97±0.89)d] and the intraoperative blood loss[(20.91±3.21)ml] in the laser group were shorter(P<0.05).The incidence of postoperative bladder perforation,obturator nerve reflex and the total incidence of postoperative complications in the laser group were 0, 0, 6.02%,respectively,which were lower than the electrical group(7.23%,9.64%,21.10%)(P<0.05).Compared with the electrical group,the laser group of Glutathione peroxidase(GSH-Px) and superoxide dismutase(SOD) were higher at T1,T2 and T3[GSH-Px:(42.84±2.98)pg/ml、(55.61±3.79)pg/ml、(74.16±5.04)pg/ml;SOD:(97.78±8.24)μmol/L、(122.57±10.03)μmol/L、(154.24±11.34)μmol/L],while malondialdehyde(MDA) was lower at T1,T2 and T3[(14.33±0.93)mmol/ml、(10.22±0.85)mmol/ml、(5.25±0.57)mmol/ml](P<0.05).During the 5-year follow-up,there were 10 cases of recurrence in the laser group and 17 cases in the electro-resection group,and there was no significant difference in the 5-year postoperative total recurrence rate(12.05% vs.20.48%) and cumulative disease-free survival rate[(87.95±3.57)% vs(79.52±4.43)%] between the two groups(P>0.05).Conclusion Compared with electro-resection of bladder tumor,laser resection is safe,efficient and reliable,with shorter operation time,lower complication rate and less stress response.

Key words: bladder tumor, non-muscular invasive bladder cancer, laser resection, electro-resection, stress

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