發(fā)布時(shí)間：2018-04-10 09:44

  本文選題：經(jīng)尿道膀胱腫瘤電切術(shù)　切入點(diǎn)：內(nèi)鏡粘膜下剝離術(shù)　出處：《山東大學(xué)》2017年碩士論文

【摘要】：[目的]比較分析經(jīng)尿道膀胱腫瘤切除術(shù)(transurethral resection of bladder tumor,TURBT)與經(jīng)尿道膀胱黏膜剝離聯(lián)合鈥激光膀胱腫瘤切除術(shù)(endoscopic submucosal dissection combined holmium laser resection of bladder tumor,ESD-HOLRBT)兩種手術(shù)方法在治療非肌層浸潤性膀腕腫瘤(non muscle-invasive bladder cancer,NMIBC)中臨床效果的安全性和有效性以及預(yù)后情況,探討未來非肌層浸潤性膀胱腫瘤治療的新方向。[方法]本研究采取回顧性分析的方法,嚴(yán)格遵循病例入選和排除標(biāo)準(zhǔn),選取山東大學(xué)附屬省立醫(yī)院保健泌尿外科自2015年1月至2016年6月期間收治的非肌層浸潤性膀胱腫瘤患者共94例。錄入患者的基本信息及臨床資料,并進(jìn)行統(tǒng)計(jì)分析。根據(jù)患者的癥狀、體征、病史、術(shù)前相關(guān)輔助檢查等,正確判斷手術(shù)指征,合理評估手術(shù)風(fēng)險(xiǎn),分別行TURBT和ESD-HOLRBT,以此分為TUR]BT手術(shù)組(A組,51例)和ESD-HOLRBT手術(shù)組(B組,43例)。針對兩組從手術(shù)時(shí)間、膀胱沖洗時(shí)間、留置導(dǎo)尿管時(shí)間、住院時(shí)間;閉孔神經(jīng)反射、電切綜合征、膀胱穿孔、尿路感染發(fā)生率;術(shù)后3個(gè)月、6個(gè)月及12個(gè)月復(fù)發(fā)情況等反應(yīng)兩種手術(shù)的有效性、安全性及預(yù)后的相關(guān)指標(biāo)進(jìn)行對照分析。應(yīng)用SPSS 20.0軟件進(jìn)行數(shù)據(jù)的錄入、統(tǒng)計(jì)、分析。兩組間定性數(shù)據(jù)采取卡方檢驗(yàn),定量數(shù)據(jù)資料以X、S表示,采取t檢驗(yàn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。[結(jié)果]所有94例患者均一次性成功完成手術(shù)。TURBT與ESD-HOLRBT兩組間年齡、性別、有無肉眼血尿、腫瘤數(shù)量、腫瘤直徑等一般信息均無明顯統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。反應(yīng)手術(shù)有效性的指標(biāo)方面,兩組手術(shù)時(shí)間、膀胱沖洗時(shí)間、留置導(dǎo)尿管時(shí)間、住院時(shí)間相比有明顯的差異(P0.05)。TURBT組僅在手術(shù)時(shí)間上優(yōu)于ESD-HOLRBT組,其余指標(biāo)均表明ESD-HOLRBT組更勝一籌。反應(yīng)手術(shù)安全性及預(yù)后的指標(biāo)方面,兩組發(fā)生閉孔神經(jīng)反射、電切綜合征、膀胱穿孔、大出血、尿路感染以及術(shù)3個(gè)月、6個(gè)月、12個(gè)月腫瘤復(fù)發(fā)率,ESD-HOLRBT較TURBT組占有明顯優(yōu)勢。[結(jié)論]1、ESD-HOLRBT具有術(shù)中失血極少,術(shù)野清晰,不發(fā)生閉孔神經(jīng)反射、膀胱穿孔及電切綜合征,術(shù)后留置尿管時(shí)間短,下床活動(dòng)恢復(fù)快,患者遭受痛苦小的優(yōu)點(diǎn)。2、ESD-HOLRBT方便切除特殊部位腫瘤,切割精準(zhǔn),幾乎無殘留,病理標(biāo)本完整,可精確判斷分級、分期,正確指導(dǎo)術(shù)后治療,極大降低了復(fù)發(fā)率。3、ESD-HOLRBT適應(yīng)證廣泛,操作簡便、過程安全、療效顯著、復(fù)發(fā)率低�？勺鳛橹委烴MIBC的理想手術(shù)方式,值得推廣。
[Abstract]:[objective] to compare transurethral resection of bladder tumor transurethral resection with transurethral bladder mucosal dissection and holmium: YAG laser submucosal dissection combined holmium laser resection of bladder tumor of bladder tumor ESD-HOLRBT in the treatment of non-myometrial infiltration.Clinical efficacy, safety and prognosis of patients with muscle-invasive bladder cancer of the wrist.To explore the new direction of non-myometrial invasive bladder tumor treatment in the future.[methods] the method of retrospective analysis was adopted in this study, and the criteria of case selection and exclusion were strictly followed.From January 2015 to June 2016, 94 patients with non-myometrial invasive bladder tumor were treated in the Department of Urology, affiliated Provincial Hospital of Shandong University.Input the patient's basic information and clinical data, and carry on the statistical analysis.According to the symptoms, signs, medical history, preoperative auxiliary examination and so on, the indication of operation was correctly judged and the operation risk was reasonably evaluated. The patients were divided into two groups: TURBT and ESD-HOLRBT (51 cases in group A) and 43 cases in group B (ESD-HOLRBT group).The incidence of obturator nerve reflex, electrocution syndrome, bladder perforation, urinary tract infection was observed in two groups, including operation time, bladder irrigation time, indwelling catheter time, hospital stay time, obturator nerve reflex, electrosurgical syndrome, bladder perforation and urinary tract infection.The efficacy, safety and prognosis of the two kinds of operations were compared and analyzed in 3 months, 6 months and 12 months after operation.The qualitative data of the two groups were chi-square test, the quantitative data were expressed as Xs, and the difference between the two groups was statistically significant by using t test (P0.05).[results] there was no significant difference in age, sex, gross hematuria, tumor number and tumor diameter between the two groups (P 0.05).The operative time, bladder irrigation time, indwelling catheter time and hospitalization time of the two groups were significantly different. The operation time of the two groups was only better than that of the ESD-HOLRBT group. The other indexes indicated that the ESD-HOLRBT group was better than the ESD-HOLRBT group.In terms of the safety and prognosis of surgery, the incidence of obturator nerve reflex, electrocution syndrome, bladder perforation, massive hemorrhage, urinary tract infection and tumor recurrence rate were significantly higher in the two groups than in the TURBT group at 3 months, 6 months and 12 months.[conclusion] 1ESD-HOLRBT has less blood loss during operation, clear operative field, no obturator nerve reflex, bladder perforation and electrocution syndrome, short indwelling time after operation, and quick recovery of bed movement.The procedure is simple, safe, effective and low recurrence rate.It can be used as an ideal surgical method for NMIBC, and it is worth popularizing.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.14

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