经尿道电汽化术联合电切术治疗表浅性膀胱肿瘤150例剖析.docVIP

经尿道电汽化术联合电切术治疗表浅性膀胱肿瘤150例剖析 　　【中图分类号】R737.14 【文献标识码】A 【文章编号】1672－3783(2012)01－0010－01 　　 【摘要】 目的:探讨经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBt)联合经尿道膀胱肿瘤气化术(transurethral vaporization of bladder tumors, TVBt)治疗浅表性膀胱肿瘤的方法及临床疗效。方法 应用TURBt结合TVBt治疗浅表性膀胱肿瘤98例,术后常规予以丝裂霉素20 mg膀胱灌注,观察其对膀胱肿瘤的治疗效果。结果 98例膀胱肿瘤均一次切除,手术平均时间34 min,未发生大出血及膀胱穿孔,平均随访18个月,术后复发15例,远处转移1例。结论 TURBt联合 TVBt治疗膀胱肿瘤具有出血少,手术视野清晰,操作简便,可多次重复,安全性高等优点。? 　　 【关键词 】 膀胱肿瘤; TURBt; TVBt;肿瘤复发 ? 　　 Clinical effects of TURBt combined with TVBt in treatment of superf icial bladder tumor? 　　 BAO Weidong? 　　 【Abstract】 Objective To explorethe methods and clinical effects of transurethral resection of bladder tumor(TURBt) combined with transurethral vaporization of bladder tumors (TVBt) in treatment of superficial bladder tumor.Methods Ninetyeight cases of superficial bladder tumor were treated by TURBt combined with TVBt and were irrigated with 40mg Epirubicin.The therapeutic effects were observed. Results All cases of superficial bladder tumor were resected in one stage without massive bleeding or vesical perforation with the mean operation time of 34 min.All patients were followed up for 6～36 months (mean 18 months).Conclusion Superficial bladder tumors can betreated by TURBt combined with TVBt withmany advantages such as less blood loss, clear operative field, convenient procedures, mutiple repeatability and high safety.? 　　 【Key words】 Bladder tumor;TURBt;TVBt 　　 我院自2002年1月―2010年1月,我科采用经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor，TURBt)结合经尿道膀胱肿瘤电气化术(transurethral vaporization of bladder tumors，TVBt)治疗浅表性膀胱肿瘤150例,取得满意疗效,现报道如下。? 　　 1 资料与方法 ? 　　1.1 临床资料:本组共150例患者资料均来自上海交通大学医学院附属新华医院崇明分院,其中男性103例,女性47例;年龄42～89岁,平均60.3岁。术前曾有无痛性肉眼血尿45例,有血块者12例,有排尿困难及尿潴溜5例,无症状及体征者10例。膀胱镜检发现单发肿瘤93例,多发57例;肿瘤直径0.5～5cm,平均1.5cm。其中临床分期Ta期30例、T1期85例、T2期35例。? 　　1.2 手术方法:手术时采取静脉麻醉或连续硬膜外麻醉,均取膀胱截石位,5%葡萄糖液、5％的甘露醇做冲洗液，按3：1比例使用。采用德国STORZ电切镜、环状切割电极,电切功率120～150W、气化功率180～240W、电凝功率60～80W,手术操作均在电视影像系统监视下进行。首先检查膀胱内肿瘤生长的部位、数目、大小、浸润深度