经尿道钬激光整块切除术与等离子电切术治疗高危非肌层浸润性膀胱癌的比较研究

doi:10.19558/j.cnki.10-1020/r.2022.06.008

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摘要 目的:探究经尿道钬激光整块切除术与等离子电切术治疗高危非肌层浸润性膀胱癌（NMIBC）的临床效果。方法:纳入2018年3月至2020年3月我院96例高危NMIBC患者,随机分为电切组（48例）和钬激光组（48例）,分别行经尿道膀胱肿瘤等离子电切术、经尿道膀胱肿瘤钬激光整块切除术治疗。比较两组手术情况、术后康复情况、血清炎性因子[高迁移率族蛋白1（HMGB1）、白细胞介素-6（IL-6）、肿瘤坏死因子α（TNF-α）]、微小RNA-200b（miR-200b）、miR-119a水平、并发症发生率。术后随访2年,比较两组复发、转移及生存状况。结果:钬激光组相比电切组出血量少[（20.86±5.08）ml vs. （23.71±5.42）ml],膀胱持续冲洗时间[（13.15±3.62）h vs. （17.08±5.13）h]、导尿管留置时间[（2.38±1.16）d vs. （4.17±1.42）d]和住院时间短[（5.03±1.37）d vs. （5.92±1.45）d],并发症总发生率低[4.17%（2/48）16.67% vs. （8/48）],差异均具有统计学意义（P<0.05）。钬激光组相比电切组术后3 d血清HMGB1、IL-6、TNF-α水平低,两组患者术后3个月相比术前血清miR-200b水平高,miR-119a水平低,差异均具有统计学意义（P<0.05）。术后随访2年,钬激光组脱落2例,电切组脱落4例。钬激光组复发率、转移率较电切组低,差异具有统计学意义（P<0.05）。结论:与经尿道膀胱肿瘤等离子电切术比较,采用经尿道膀胱肿瘤钬激光整块切除术治疗高危NMIBC疗效可靠,且能明显减轻手术创伤,降低术后并发症发生率,促进术后康复,减少肿瘤复发和转移。

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	马光
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	李俊鹏
	辛立升
	王志勇

关键词 ：膀胱肿瘤, 钬, 并发症

Abstract：Objective: To investigate the clinical effect of transurethral holmium laser en bloc resection and plasma electrosurgery in the treatment of high-risk non-muscle invasive bladder cancer （NMIBC）. Methods: 96 patients with high-risk NMIBC in our hospital from March 2018 to March 2020 were selected and randomly divided into electrosurgery group （48 cases） and holmium laser group （48 cases）. The holmium laser group was treated with en bloc holmium laser resection of the bladder tumor through the urethra. The operation conditions （operation time, blood loss）, postoperative rehabilitation （continuous bladder irrigation time, urinary catheter indwelling time, hospital stay）, tthe incidence of complications and serum inflammatory factors [High mobility group protein 11 （HMGB1）, interleukin-6 （IL-6）, tumor necrosis factor alpha （TNF-α）], microRNA-200b （miR-200b）, miR-119a levels, postoperative follow-up 2 Years, the recurrence, metastasis and survival status of the two groups were statistically compared. Results: Compared with electrosurgery group, holium laser group had lower hemorrhagic volume [（20.86±5.08）ml vs. （23.71±5.42）ml], duration of persistent bladder irrigation [（13.15±3.62）h vs. （17.08±5.13）h], duration of catheter indwelling [（2.38±1.16）d vs. （4.17±1.42）d], and short hospital stay [（5.03±1.37）d vs. （5.92±1.45）d], and lower overall complication rate [4.17%（2/48）16.67%vs（8/48）], with statistical significance （P<0.05）.Serum levels of HMGB1, IL-6, and TNF-α were lower in the holimu laser group than in electrosurgery group at 3 days postoperatively, and the differences in serum levels of miR-200b and miR-119a were significant （P<0.05）.After postoperative follow-up of 2 years, 2 patients in the holium laser group and 4 in the electrosurgery group had radiographic drops.The recurrence and metastasis rates were lower in the holium laser group than in the electrosurgery group, and the difference was statistically significant （P<0.05）. Conclusion: Compared with transurethral plasma electroresection of bladder tumor, transurethral en bloc resection of bladder tumor with holmium laser in the treatment of high-risk NMIBC has a reliable effect, and can significantly reduce the surgical trauma, reduce the incidence of postoperative complications, and promote postoperative recovery. Reduce tumor recurrence and metastasis.

Key words： bladder tumor holmium complications

收稿日期: 2022-09-13

基金资助:承德市科学技术研究与发展计划项目（202006A056）

通讯作者: 马光,toaleau28@21cn.com

引用本文:

马光, 李红阳, 宋殿宾, 马红亮, 李俊鹏, 辛立升, 王志勇. 经尿道钬激光整块切除术与等离子电切术治疗高危非肌层浸润性膀胱癌的比较研究[J]. 微创泌尿外科杂志, 2022, 11(6): 396-401.
Ma Guang, Li Hongyang, Song Dianbin, Ma Hongliang, Li Junpeng, Xin Lisheng, Wang Zhiyong. A comparetive study of transurethral holmium laser en bloc resection versus plasma electrosurgery for high-risk non-muscle invasive bladder cancer. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(6): 396-401.

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[1] Liu X,Jiang J,Yu C,et al. Secular trends in incidence and mortality of bladder cancer in China, 1990-2017: A joinpoint and age-period-cohort analysis[J].Cancer Epidemiol, 2019,61(1): 95-103.
[2] Powles T,Bellmunt J,Comperat E,et al. Electronic address: clinicalguidelines@esmo.org. Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up[J].Ann Oncol, 2022,33(3): 244-258.
[3] Babjuk M,Burger M,Compérat EM,et al. European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and Carcinoma In Situ) - 2019 Update[J].Eur Urol, 2019,76(5): 639-657.
[4] 岐宏政,陈刚,汪自力,等. 经尿道红激光膀胱肿瘤切除术和经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌的疗效及安全性评价[J].临床和实验医学杂志, 2020,19(18): 1978-1980.
[5] Sylvester RJ,Rodríguez O,Hernández V,et al. European Association of Urology (EAU) Prognostic Factor Risk Groups for Non-muscle-invasive Bladder Cancer (NMIBC) Incorporating the WHO 2004/2016 and WHO 1973 Classification Systems for Grade: An Update from the EAU NMIBC Guidelines Panel[J].Eur Urol, 2021,79(4): 480-488.
[6] 齐琳. 膀胱癌手术常见并发症及其防治[J].现代泌尿外科杂志, 2020,25(1): 7-10.
[7] Yu J,Zheng J. Comparative efficacy and safety of transurethral laser surgery with holmium laser, KTP laser, 2-micron laser or thulium laser for the treatment of non-muscle invasive bladder carcinoma: a protocol of network meta-analysis[J].BMJ Open, 2021,11(12): e055840.
[8] Chang SS,Boorjian SA,Chou R,et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline[J].J Urol, 2016,196(4): 1021-1029.
[9] 中国研究型医院学会泌尿外科学专业委员会,中国医疗保健国际交流促进会泌尿健康促进分会,中国医疗保健国际交流促进会循证医学分会,等. 中国非肌层浸润性膀胱癌治疗与监测循证临床实践指南(2018年标准版)[J].现代泌尿外科杂志, 2019,24(7): 516-542.
[10] Kim LHC,Patel MI. Transurethral resection of bladder tumour (TURBT)[J].Transl Androl Urol, 2020,9(6): 3056-3072.
[11] Bilim V,Hoshi S. Prostatic urethra recurrence after transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC)[J].Clin Case Rep, 2022,10(1): e05256.
[12] 段晓波,代庆德,周婷婷.非肌层浸润性膀胱癌采用两种TURBT术治疗的效果及预后对比研究[J].临床和实验医学杂志, 2020,19(12): 1322-1325.
[13] 李昱亮,庞建,魏琪波.经尿道膀胱肿瘤整块切除术治疗非肌层浸润性膀胱癌的疗效分析[J].癌症进展, 2019,17(11): 1296-1298.
[14] Zhou Y,Zhang ZL,Luo MH,et al. Transurethral needle electrode resection and transurethral holmium laser resection of bladder cancer[J].World J Surg Oncol, 2020,18(1): 166.
[15] Razzaghi MR,Mazloomfard MM,Yavar M,et al. Holmium LASER in comparison with transurethral resection of the bladder tumor for non-muscle invasive bladder cancer: randomized clinical trial with 18-month follow-up[J].Urol J, 2021,18(4): 460-465.
[16] Maheshwari PN,Arora AM,Sane MS,et al. Safety, feasibility, and quality of holmium laser en-bloc resection of nonmuscle invasive bladder tumors - a single-center experience[J].Indian J Urol, 2020,36(2): 106-111.
[17] 赵色玲,刘焜,陈水兰,等. 经尿道钬激光膀胱肿瘤整块切除术与经尿道膀胱肿瘤电切术治疗非肌层浸润性膀胱癌的对比研究[J].国际泌尿系统杂志, 2021,41(3): 411-415.
[18] 符秀林,史南,刘睿,等. 泌尿系结石患者术后尿道感染与IL-6和TNF-α及HMGB1基因多态性的关联性[J].中华医院感染学杂志, 2021,31(11): 1686-1691.
[19] Zaharuddin L,Mokhtar NM,Muhammad Nawawi KN,et al. A randomized double-blind placebo-controlled trial of probiotics in post-surgical colorectal cancer[J].BMC Gastroenterol, 2019,19(1): 131.
[20] 石小玲,顾叶飞,蔡芸.膀胱癌组织和血清miR-200b甲基化状态与EMT及临床病理特征的相关性研究[J].东南大学学报(医学版), 2022,41(1): 95-101.
[21] 吴德柱,李清林,彭娜,等. 膀胱癌患者血清miR-21、miR-119a表达量与肿瘤恶性增殖及侵袭的相关性分析[J].转化医学杂志, 2022,11(1): 9-13,8.