应用450nm蓝激光半导体治疗机侧出光纤联合黏膜下注射甘油果糖盐水的经尿道膀胱黏膜剥脱术疗效初探（“大家泌尿网”观看手术视频）

Efficacy of 450 nm blue laser semiconductor treatment machine with submucosal injection of glycerol and fructose saline in bladder tumor endoscopic submucosal dissection

摘要

目的 探讨应用450 nm蓝激光半导体治疗机侧出光纤联合黏膜下注射甘油果糖盐水在经尿道膀胱黏膜剥脱术（BT-ESD）治疗非肌层浸润性膀胱癌的安全性和有效性。方法 回顾性分析2023年11月-2024年4月泰安市中心医院迎胜院区泌尿肾病激光治疗中心行经450 nm蓝激光半导体治疗机侧出光纤黏膜下注射甘油果糖盐水的BT-ESD治疗的20例膀胱癌患者的临床资料。其中男性13例，女性7例，年龄（64.95±6.89）岁，肿瘤直径（1.02±0.24）cm，术前血红蛋白（Hb）（130.55±4.36）g/L。记录手术时间、术后次日Hb、肿瘤基底活检阳性率、术后膀胱冲洗时间、尿管留置时间、术后住院时间、并发症发生情况、术后复发率等。结果 所有患者均顺利完成手术，共切除病灶28个。术后病理结果证实均为非肌层浸润性膀胱癌，基底黏膜活检均为阴性。手术时间（9.40±3.14）min、术后次日Hb（130.15±4.59）g/L同术前相比差异无统计学意义（P＞0.05）。术后膀胱冲洗时间（17.70±1.34）h，尿管留置时间1 d，术后住院时间1 d。术中未发生闭孔神经反射、膀胱穿孔、输血等并发症及中转开放、术后二次出血情况，所有患者术后6个月复查均未见肿瘤复发。结论 应用450 nm蓝激光半导体治疗机侧出光纤联合黏膜下注射甘油果糖盐水行BT-ESD治疗非肌层浸润性膀胱癌安全、有效，该术式具备整块剜除膀胱肿瘤、术后基底层面清晰、出血量少、手术时间短、并发症少等优势，推荐其作为日间手术并临床推广。

Abstract

Objective To explore the safety and efficacy of submucosal injection of glycerol and fructose saline in bladder tumor endoscopic submucosal dissection (BT-ESD) with a 450 nm blue laser semiconductor treatment machine in the treatment of non-muscular invasive bladder cancer (NMIBC). Methods Clinical data of 20 patients with bladder tumor treated with submucosal injection of glycerol and fructose saline BT-ESD via a 450 nm blue laser semiconductor treatment machine at our hospital during Nov. 2023 and Apr. 2024 were retrospectively analyzed. The patients included 13 males and 7 females, aged (64.95 ± 6.89) years, tumor diameter (1.02 ± 0.24) cm, and preoperative hemoglobin (Hb) (130.55 ± 4.36) g/L. The operation time, Hb the next day after operation, positive rate of tumor basal biopsy, postoperative bladder irrigation time, catheter indwelling time, postoperative hospital stay, complications and recurrence rate were recorded. Results All operations were successful, and 28 lesions were removed. The postoperative pathological results confirmed that all cases were NMIBC, and the basal mucosa biopsies were negative. The operation time was (9.40 ± 3.14) min, postoperative Hb (130.15 ± 4.59) g/L, bladder irrigation time (17.70 ± 1.34) h, catheter indwelling time 1 day, and postoperative hospital stay 1 day. There were no complications such as obturator nerve reflex, bladder perforation. There were no need for blood transfusion, no conversion to open surgery, and no secondary bleeding after operation. No tumor recurrence was found during 6-month postoperative follow up. Conclusion Submucosal injection of glycerol and fructose saline BT-ESD with a 450 nm blue laser semiconductor treatment machine is a safe and effective method for the treatment of NMIBC. It has advantages of whole enucleation of bladder tumor, clear basal layer, small amount of bleeding, short operation time and few complications. It can be used as a day surgery and is worthy of clinical promotion.

关键词

450 nm蓝激光半导体治疗机 / 侧出光纤 / 甘油果糖盐水 / 膀胱黏膜剥脱术 / 非肌层浸润性膀胱癌

Key words

450 nm blue laser semiconductor treatment machine / lateral optical fiber / glycerol and fructose saline / bladder mucosal exfoliation / non-muscular invasive bladder cancer

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