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目的:总结经尿道钬激光(Ho:YAG激光)治疗浅表性膀胱肿瘤的临床体会。方法:2005年7月～2008年2月对92例浅表性膀胱癌患者采用Ho:YAG激光治疗,其中肿瘤单发56例,多发36例。肿瘤直径0.5～4 cm。术前病理检查均提示为低级别尿路上皮癌。11例年老和一般情况差者采用局麻。结果:手术均一次成功,术后创面基底及创缘病理检查无残余肿瘤,术后均按常规方法用化疗药物行膀胱灌注,并定期随访,每3个月复查膀胱镜。手术时间平均18 min(10～50 min),出血极少,无膀胱穿孔及术后继发出血等并发症。术后留置导尿1～3天,最短14 h。局麻患者术后即可进食并起床活动。术后住院1～3天,其中43例为日间手术(入院当天手术,第2天出院)。术后随访平均15个月(2～31个月),12例复发(13.3%),再次激光或电切治疗。结论:经尿道Ho:YAG激光治疗浅表性膀胱癌安全,微创,患者耐受性好,疗效与传统TURBT相似。
Objective: To summarize the clinical experience of transurethral holmium laser (Ho: YAG laser) in the treatment of superficial bladder tumor. Methods: From July 2005 to February 2008, 92 patients with superficial bladder cancer were treated with Ho: YAG laser. Among them, 56 were single and 36 were multiple. Tumor diameter 0.5 ~ 4 cm. Preoperative pathological examination prompted a low-grade urothelial carcinoma. Eleven patients were elderly and under general anesthesia with local anesthesia. Results: The operation was successful all the time. No residual tumor was found in the wound surface and wound edge. All patients were treated with chemotherapeutic drugs by intravesical instillation after operation and were followed up regularly. Cystoscopy was performed every 3 months. The average operation time was 18 min (10-50 min), with minimal bleeding, no bladder perforation and postoperative bleeding complications. Postoperative catheterization 1 to 3 days, the shortest 14 h. Local anesthesia patients can eat and get up after surgery. Postoperative hospital 1 to 3 days, of which 43 cases were day surgery (admission day surgery, discharged on the second day). The patients were followed up for an average of 15 months (range 2 to 31 months) and 12 patients (13.3%) were treated with laser or electrosurgical resection. Conclusion: Transurethral Ho: YAG laser treatment of superficial bladder cancer is safe, minimally invasive and well tolerated. The curative effect is similar to that of traditional TURBT.