本文選題：非肌層浸潤性膀胱癌(NMIBC) + 經(jīng)尿道膀胱腫瘤內(nèi)鏡黏膜下剝離術(shù)(BT-ESD)��； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:比較利用海博刀行經(jīng)尿道膀胱腫瘤內(nèi)鏡下黏膜下剝離術(shù)(BT-ESD)與經(jīng)尿道膀胱腫瘤電切術(shù)(TURBT)治療淺表性膀胱腫瘤的療效,探索BT-ESD治療淺表性膀胱腫瘤的安全可行性及有效性,評價BT-ESD的臨床應(yīng)用價值。方法:收集并分析我院2015年01月至2016年12月期間54例淺表性膀胱腫瘤患者臨床資料,24例患者經(jīng)BT-ESD治療,30例經(jīng)TURBT治療,記錄手術(shù)時間、膀胱持續(xù)沖洗時間、出血情況、膀胱穿孔、閉孔神經(jīng)反射等相關(guān)并發(fā)癥、導(dǎo)尿管留置時間、術(shù)后住院時間及隨訪術(shù)后1年內(nèi)復(fù)發(fā)狀況。術(shù)后定期膀胱灌注化療。結(jié)果:兩治療組手術(shù)均順利完成。BT-ESD組24例患者切除獨立病灶31處,直徑為10-40mm,28個腫瘤完整取出,3個切碎取出;BT-ESD組手術(shù)時間(73.33±34.06)min與TURBT組(52±39.73)min相比,差異有統(tǒng)計學(xué)意義(P0.05);BT-ESD組膀胱沖洗時間(0.667±0.817)d,TURBT組(1.33±0.99)d,差異有統(tǒng)計學(xué)意義(P0.05);BT-ESD組導(dǎo)尿管留置時間(3.375±1.24)d少于TURBT組(5.40±1.99)d,差異有統(tǒng)計學(xué)意義(P0.05);BT-ESD術(shù)后住院時間少于TURBT組,差異有統(tǒng)計學(xué)意義(P=0.001);BT-ESD組有1例出血,無其他并發(fā)癥;TURBT組閉孔神經(jīng)反射7例,膀胱穿孔2例,出血5例,術(shù)后住院時間7天11例,總共11位患者發(fā)生并發(fā)癥。兩組間總的并發(fā)癥發(fā)生率有統(tǒng)計學(xué)意義(P0.05);其中BT-ESD組閉孔神經(jīng)反射、術(shù)后住院時間大于7天的發(fā)生率與TURBT相比,差異有統(tǒng)計學(xué)意義(P0.05);兩組間的膀胱穿孔、出血方面,差異無統(tǒng)計學(xué)意義(P0.05)。BT-ESD組15例隨訪12個月,尚未見復(fù)發(fā)。TURBT組19例患者經(jīng)12個月隨訪,6例患者復(fù)發(fā),復(fù)發(fā)率為31.58%(6/19),差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1.BT-ESD作為淺表性膀胱癌的腔內(nèi)微創(chuàng)治療是安全可行有效的;2.BT-ESD完整切除的腫瘤組織標(biāo)本保存完好,使病理醫(yī)師更加精確了腫瘤分期分級,對后續(xù)治療、預(yù)后判斷有重要的臨床意義;3.BT-ESD與TURBT相比可明顯減少手術(shù)并發(fā)癥,提高手術(shù)效果,縮短了術(shù)后恢復(fù)時間;4.短期隨訪BT-ESD可顯著有效降低患者術(shù)后腫瘤復(fù)發(fā)率。
[Abstract]:Objective: to compare the efficacy of transurethral endoscopic submucosal dissection of bladder tumor (BT-ESD) and transurethral resection of bladder tumor (TURBT) in the treatment of superficial bladder tumor with Haibo knife, and to explore the safety and efficacy of BT-ESD in the treatment of superficial bladder tumor. To evaluate the clinical value of BT-ESD. Methods: the clinical data of 54 patients with superficial bladder tumor from January 2015 to December 2016 were collected and analyzed. 24 patients were treated with BT-ESD and 30 patients were treated with TURBT. The time of operation, the duration of bladder irrigation, bleeding and bladder perforation were recorded. Related complications such as obturator nerve reflex, catheter indwelling time, postoperative hospitalization time and recurrence status within 1 year follow up. Postoperative intravesical chemotherapy was performed regularly. Results: the operation time of BT-ESD group was 73.33 鹵34.06)min and that of BT-ESD group was 73.33 鹵39.73)min compared with that of TURBT group, the diameter was 10-40mm, 28 tumors were removed completely, and the operation time of BT-ESD group was 73.33 鹵39.73)min. There was significant difference in bladder irrigation time (0.667 鹵0.817 d) and urinary catheter indwelling time (3.375 鹵1.24 days) in BT-ESD group (P 0.05 鹵0.99 d), and the hospitalization time after BT-ESD operation in TURBT group was significantly less than that in TURBT group (P 0.05 鹵1.99 d). There was no significant difference in the duration of bladder irrigation between BT-ESD group and BT-ESD group (P 0.05 鹵0.817 d), and the time of indwelling urethral catheter in BT-ESD group was less than that in TURBT group (P 0.05 鹵1.24 d, P < 0.05 鹵1.99 d). The difference was statistically significant in BT-ESD group (P < 0.001). There were 1 case of hemorrhage, 7 cases of obturator nerve reflex, 2 cases of bladder perforation and 5 cases of hemorrhage in TURBT group. The postoperative hospitalization time was 7 days in 11 cases. The incidence of complications in BT-ESD group was significantly higher than that in TURBT group (P 0.05), the incidence of obturator nerve reflex in BT-ESD group was longer than 7 days after operation, and there was significant difference between the two groups in the incidence of bladder perforation and hemorrhage. No significant difference was found in 15 patients in the P0.05U. BT-ESD group for 12 months, 19 patients in the TURBT group were followed up for 12 months, and the recurrence rate was 31.58 / 19. The difference was statistically significant (P 0.05). Conclusion: 1. BT-ESD is a safe, effective and safe minimally invasive treatment for superficial bladder cancer. 2. The intact specimens of BT-ESD have been preserved well, which makes the pathologist more accurate in staging and grading of the tumor and in the follow-up treatment. 3. BT-ESD can significantly reduce the complications, improve the effect and shorten the time of postoperative recovery compared with TURBT. 3. Short-term follow-up BT-ESD can significantly reduce the recurrence rate of postoperative tumor.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.14

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