铥激光在上尿路上皮癌手术中的应用价值

Application value of the thulium laser in the radical resection for upper urinary tract urothelial carcinoma

关键词:  上尿路上皮肿瘤  输尿管膀胱壁内段  铥激光

Key words:  upper urinary tract urothelial tumors  ureter bladder wall section  Thulium laser

摘要:

目的探讨经尿道铥激光切除输尿管膀胱壁内段在输尿管癌根治中的应用价值。方法回顾性非随机对42例行输尿管癌根治术的患者进行比较研究,10例利用铥激光（A组）切除输尿管膀胱壁内段,12例利用钬激光（B组）切除输尿管膀胱壁内段,20例为开放手术（C组）。比较三组的手术时间、出血量、住院时间、肿瘤复发率。结果铥激光组手术时间（120±45）min、出血量（100±52）ml、术后留置盆腔负压引流时间（7.2±2.2）d、术后留置导尿时间（8±3）d、住院时间（10±2）d;钬激光组手术时间（128±47）min、出血量（120±48）ml、术后留置盆腔负压引流时间（6.6±2.5）d、术后留置导尿时间（9±2）d、住院时间（11±3）d;开放手术组手术时间（228±55）min、出血量（330±90）ml、术后留置盆腔负压引流时间（7.6±3.0）、术后留置导尿时间（8±3）d、住院时间（13±2）d。开放手术（C组,n=20）分别与铥激光（A组,n=10）和钬激光（B组,n=12）两组比较,平均手术时间、平均出血量、平均住院时间差异均有统计学意义,而留置扁平管与导尿管的时间差异均无统计学意义（P〉0.05）,A、B两组则以上指标差异均无统计学意义。结论在输尿管癌根治术中,利用铥激光切除输尿管膀胱壁内段其效果与钬激光及开放手术切除类似,且具有手术时间短,术中出血少及术后恢复快等优势。

Abstract:

Objective To study the application of the technique of thulium laser in managing bladder cuff in nephroureterectomy in the radical resection of ureteral carcinoma. Methods Forty-two patients with radical resection of ureteral carcinoma were enrolled in a retrospective comparative nonrandomized study. Of them,10 patients used the technique of thulium laser（ group A） in managing bladder cuff in nephroureterectomy,12 patients used the technique of holmium laser（ group B） and 20 patients used the open surgery（ group C）. The operation time,intra-operative blood loss volume,hospital stays and incidence of bladder tumors in post-operative were compared. Results In group A,the operation time was（ 120 ± 45） minutes,the intra-operative blood loss volume was（ 100 ± 52） ml,the negative pressure drainage was（ 7. 2 ± 2. 2） days,the retention catheterization was（ 8 ± 3） days and the hospital stays was（ 10 ± 2） days. In group B,the operation time was（ 128 ± 47） minutes,the intraoperative blood loss volume was（ 120 ± 48） ml,the negative pressure drainage was（ 6. 6 ± 2. 5） d,the retention catheterization was（ 9 ± 2） days,the hospital stays was（ 11 ± 3） d. In group C,the operation time was（ 228 ± 55） minutes,the intra-operative blood loss volume was（ 330 ± 90） ml,the negative pressure drainage was（ 7. 6 ± 3. 0） days,the retention catheterization（ 8 ± 3） days,the hospital stays was（ 13 ± 2） days. Group C had no statistical differences with group A and group B in terms of removal time of negative pressure drainage and removal time of catheter. But significant statistical differences existed in terms of operative duration,intraoperative blood loss volume and hospital stay（ P〈0. 05）. No statistical differences existed between groups B and group C in terms of all the above indicators.Conclusion In the radical resection of ureteral carcinoma,thulium laser technique has no difference in the result of operation compared with holmium laser and open