本文選題：膀胱腫瘤　切入點(diǎn)：2μm激光　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：建立經(jīng)尿道2μm激光膀胱部分切除術(shù)治療膀胱腫瘤新術(shù)式、分析應(yīng)用此方法治療膀胱腫瘤的臨床特點(diǎn)；分析此方法所獲標(biāo)本的病理組織學(xué)特點(diǎn)、觀察腫瘤病理分期,隨診觀察2μm激光手術(shù)對(duì)膀胱壁組織形態(tài)學(xué)的影響、總結(jié)分析膀胱腫瘤患者術(shù)后的隨診特點(diǎn)。 方法：在2011年5月至2013年7月間,通過術(shù)前檢查,選取我科住院的膀胱尿路上皮癌患者,采用經(jīng)尿道2μm激光膀胱部分切除術(shù)進(jìn)行治療。分析手術(shù)特點(diǎn),觀察臨床療效；對(duì)所獲得標(biāo)本進(jìn)行病理切片分析；總結(jié)患者隨診結(jié)果,分析膀胱腫瘤患者術(shù)后的隨診特點(diǎn)。 結(jié)果：所有患者在靜脈復(fù)合或椎管麻醉下均可耐受經(jīng)尿道2gm激光膀胱部分切除術(shù)。手術(shù)時(shí)間8～45分鐘,術(shù)中幾乎不出血,無閉孔神經(jīng)反射,術(shù)后亦無繼發(fā)出血；切除瘤體的組織病理學(xué)分析證實(shí)：該方法可將瘤體及其附著的膀胱粘膜、粘膜下層及全部肌層完整切除,切緣無癌細(xì)胞殘留；術(shù)后隨訪3-15個(gè)月,無原位復(fù)發(fā)。本組尿路上皮癌患者隨訪近1年生存率100%,生活質(zhì)量較好,隨診配合率高。 結(jié)論：(1)經(jīng)尿道2μm激光膀胱部分切除術(shù)治療膀胱腫瘤是一種安全有效的新方法。由于2μm激光可以做到對(duì)膀胱壁全層精細(xì)的分層解剖,手術(shù)可以在肌層與外層疏松結(jié)締組織之間進(jìn)行剝離,因此可以達(dá)到膀胱部分切除的目的。2μm激光膀胱部分切除術(shù)不僅可以有效地治療侵及粘膜固有層的非肌層浸潤(rùn)性腫瘤,也可以治療侵及局部肌層的浸潤(rùn)性腫瘤。這樣可能為治療部分浸潤(rùn)性膀胱腫瘤開辟了新途徑。(2)經(jīng)尿道2gm激光膀胱部分切除術(shù)所獲得的標(biāo)本,腫瘤及其附著的膀胱壁全層組織完整,可準(zhǔn)確判定腫瘤的臨床分期,有效地指導(dǎo)后續(xù)治療,術(shù)后創(chuàng)面恢復(fù)良好。(3)采用經(jīng)尿道2μm激光膀胱部分切除術(shù),對(duì)腫瘤組織的破壞較少,可以保持瘤體的完整性。(4)應(yīng)用經(jīng)尿道2μm激光膀胱部分切除術(shù),對(duì)于治療非浸潤(rùn)性膀胱腫瘤和浸潤(rùn)性膀胱腫瘤都是有意義的：對(duì)非浸潤(rùn)性膀胱腫瘤患者,手術(shù)安全可靠,療效明確,可以很好的制定患者個(gè)性化治療方案,減少不必要的手術(shù)并發(fā)癥。對(duì)于浸潤(rùn)性膀胱腫瘤患者術(shù)后療效滿意,生活質(zhì)量較好,患者選擇保留膀胱及正常排尿功能的意愿得到尊重。
[Abstract]:Objective: to establish a new method of transurethral partial cystectomy with 2 渭 m laser for the treatment of bladder tumor, to analyze the clinical features of this method, to analyze the histopathological characteristics of the specimens obtained by this method, and to observe the pathological stages of the tumor. To observe the effect of 2 渭 m laser surgery on bladder wall histomorphology, and to summarize and analyze the characteristics of postoperative follow-up of bladder tumor patients. Methods: from May 2011 to July 2013, the patients with bladder urothelial carcinoma in our department were selected and treated by transurethral 2 渭 m laser cystectomy. The pathological sections of the specimens were analyzed, and the results of follow-up were summarized, and the characteristics of postoperative follow-up of bladder tumor patients were analyzed. Results: transurethral partial cystectomy with 2gm laser was tolerated in all patients under intravenous or spinal anaesthesia. The operative time was 845 minutes. There was almost no bleeding, no obturator nerve reflex and no secondary bleeding after operation. Histopathological analysis showed that the tumor and its adherent bladder mucosa, submucosa and all myometrium could be removed completely, and no cancer cells remained in the incised margin. In this group of patients with urothelial carcinoma, the 1 year survival rate was 100%, the quality of life was better and the cooperation rate of follow-up was high. Conclusion transurethral partial cystectomy with 2 渭 m laser is a safe and effective method for the treatment of bladder tumors. Surgery can be performed between the muscular layer and the outer loose connective tissue, so that the partial cystectomy can be achieved. 2 渭 m laser partial cystectomy can not only effectively treat non-myometrial infiltrating tumors involving the lamina propria of the mucous membrane. This may open up a new approach to the treatment of partially invasive bladder tumors, and may open up a new approach to the treatment of partial cystectomy by transurethral 2gm laser cystectomy. The complete tissue of the tumor and its attached bladder wall can accurately determine the clinical stage of the tumor and guide the follow-up treatment effectively. The wounds recovered well after operation. The partial cystectomy with transurethral 2 渭 m laser can do little damage to the tumor tissue. Partial cystectomy with transurethral 2 渭 m laser is of significance in the treatment of both non-invasive bladder tumors and invasive bladder neoplasms: it is safe and reliable for patients with non-invasive bladder tumors. The curative effect is clear, can make the patient individuation treatment plan very well, reduce unnecessary operation complication, the curative effect is satisfied for the patient with invasive bladder tumor, the quality of life is better, The patient's willingness to choose to retain bladder and normal urination function was respected.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.14

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄢俊安,宋波,熊恩慶,劉南,潘進(jìn)洪;鈥激光治療表淺膀胱癌的療效[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2003年22期

2 韓蘇軍;張思維;陳萬青;李長(zhǎng)嶺;;中國(guó)膀胱癌發(fā)病現(xiàn)狀及流行趨勢(shì)分析[J];癌癥進(jìn)展;2013年01期

3 曹志剛;劉軍;蘇江浩;沈明順;;經(jīng)尿道鈥激光輔助化療藥物治療膀胱腫瘤52例[J];淮海醫(yī)藥;2007年03期

4 李健;李天惠;張庭松;;綠激光氣化術(shù)治療表淺膀胱癌[J];醫(yī)學(xué)臨床研究;2007年01期

5 鄒龍?jiān)?馮華國(guó);周樂友;;鈥激光腔內(nèi)切除巨大膀胱腫瘤[J];醫(yī)學(xué)臨床研究;2007年10期

6 鄒龍?jiān)?馮華國(guó);周樂友;趙杰;;保留膀胱鈥激光腔內(nèi)治療浸潤(rùn)性膀胱癌的療效觀察[J];醫(yī)學(xué)臨床研究;2008年06期

7 鄒華斌;;探討如何提高經(jīng)尿道膀胱腫瘤電切術(shù)的療效和安全性以及并發(fā)癥的防治措施[J];中外醫(yī)療;2011年11期

8 章詠裳;經(jīng)尿道電切術(shù)治療膀胱及前列腺疾病[J];臨床泌尿外科雜志;2000年10期

9 蔡曉晴,李文光;膀胱鏡下Nd:YAG激光治療膀胱復(fù)發(fā)性腫瘤療效觀察[J];臨床泌尿外科雜志;2001年06期

10 賈永中;肖序仁;;RevoLix 2μm激光治療淺表膀胱腫瘤的療效觀察[J];臨床泌尿外科雜志;2008年11期

，

本文編號(hào)：1638402