[1]黄一亮* 李超 王继前.经尿道钬激光膀胱肿瘤整块切除术联合化疗治疗肌层浸润性膀胱癌27例[J].中国微创外科杂志,2019,01(11):1036-1056.
　Huang Yiliang,Li Chao,Wang Jiqian..Transurethral Holmium Laser en bloc Resection of Bladder Tumors Combined With Chemotherapy for Treating 27 Cases of Muscle Invasive Bladder Cancer[J].Chinese Journal of Minimally Invasive Surgery,2019,01(11):1036-1056.
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经尿道钬激光膀胱肿瘤整块切除术联合化疗治疗肌层浸润性膀胱癌27例()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2019年11期
页码:
1036-1056
栏目:
经验交流
出版日期:
2019-11-25

文章信息/Info

Title:
Transurethral Holmium Laser en bloc Resection of Bladder Tumors Combined With Chemotherapy for Treating 27 Cases of Muscle Invasive Bladder Cancer
作者:
黄一亮* 李超 王继前
（厦门市海沧医院泌尿外科，厦门361026）
Author(s):
Huang Yiliang;  Li Chao;  Wang Jiqian.
Department of Urology, Haicang Hospital, Xiamen 361026, China
关键词:
钬激光; 肌层浸润性膀胱癌; 整块切除; 吉西他滨
Keywords:
Holmium laser; Muscle invasive bladder cancer; The en bloc resection; Gemcitabine
文献标志码:
B
摘要:
目的探讨肌层浸润性膀胱癌（muscle invasive bladder cancer, MIBC）行经尿道钬激光膀胱肿瘤整块切除（En bloc resection）联合化疗的临床疗效。方法我院2015年6月～2017年12月对27例MIBC(拒绝或无法耐受根治性膀胱切除术)采用经尿道钬激光膀胱肿瘤整块切除，术中沿肿瘤基底周边1 cm环形切除肿瘤，切除深度达膀胱浆膜层，同时创面基底部活检。术后1周丝裂霉素40 mg局部膀胱灌注（1次/周，共8次，后改为1次/月，共1年），吉西他滨1000 mg/m2（第1、8、15天）+顺铂70 mg/m2（第2天）静脉化疗，4周为1个周期，共2～4周期。结果27例均顺利完成手术，手术时间20～48 min，平均32.4 min。术中膀胱冲洗液量4.2～9.6 L，未出现明显出血、闭孔神经反射。术后留置三腔气囊尿管1～3 d。术后病理为浸润性乳头状尿路上皮癌，G1期14例，G2期8例，G3期5例；基底部活检阳性1例。27例术后随访6～24个月，平均13个月，5例（18.5%）局部复发，首次复发时间3～18个月（中位时间10个月），1例术后13个月死于远处转移，1例术后18个月死于脑血管意外。结论经尿道膀胱肿瘤钬激光整块切除联合化疗治疗MIBC，出血少，副作用轻，病理分期精准，可作为不愿行膀胱癌根治患者的替代治疗方案。
Abstract:
ObjectiveTo explore the clinical efficacy of transurethral holmium laser en bloc resection of bladder tumors combined with chemotherapy in the treatment of muscle invasive bladder cancer (MIBC).MethodsA total of 27 patients with MIBC　unwilling　or intolerance of radical cystectomy were enrolled from June 2015 to December 2017. Holmium laser was used to resect the bladder tumor en bloc. During the operation, the tumor was resected in a circle of 1 cm around the base of the tumor. The depth of resection reached to the serosa layer of the bladder. At the same time, biopsy was performed at the base of the wound. One week after operation, local intravesical instillation of mitomycin 40 mg (1 time/week, 8 times in total, changed to 1 time/month, 1 year in total), and intravenous chemotherapy of gemcitabine 1000 mg/m2 (day 1, 8, 15) combined with cisplatin 70 mg/m2 (day 2) were given, with 4 weeks for 1 cycle, 2-4 cycles in total.ResultsThe operations were smooth in all the 27 cases. The operation time was 20-48 min (mean, 32.4 min). The intraoperative rinses quantity was 4.2-9.6 L．No obvious bleeding or obturator reflex occurred. The postoperative catheterization time was 1-3 days. The pathologic diagnosis was invasive urothelial carcinoma, with G1 grade in 14 cases, G2 grade in 8 cases, and G3 grade in 5 cases. The basal biopsy was positive in 1 case. The 27 cases were followed up for 6-24 months, with an average of 13 months. Five cases (18.5%) had local recurrence. The first recurrence time was 3-18 months (median, 10 months). One case died of distant metastasis 13 months after operation, and one case died of cerebrovascular accident 18 months after operation.ConclusionsTransurethral holmium laser en bloc resection of bladder tumors with chemotherapy for MIBC has advantages of less blood loss, mild side effects, and accurate pathologic diagnosis. It could be an effective alternative for patients unwilling to accept radical cystectomy．

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备注/Memo

备注/Memo:
*通讯作者，Email:9803187@163.com
更新日期/Last Update: 2020-03-03