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目的探讨应用经尿道双极等离子电切系统治疗膀胱癌的安全性和疗效。方法采用英国Gyrus公司的经尿道双极等离子电切系统行经尿道膀胱肿瘤电切术(transurethral resection of the bladder tumor,TURBT)治疗膀胱癌85例,切割电极切除肿瘤直达深肌层,同时扩大到电切距肿瘤基底1 cm范围的正常组织,术后定期膀胱内灌注吡柔比星。结果手术时间10~52 min,平均23 min。术中发生闭孔神经反射19例,其中腹膜外穿孔2例。64例随访3~72个月,平均21个月,复发17例(术后6~12个月3例复发,1~2年9例复发,2~5年5例复发),行1~4次电切8例,膀胱部分切除5例,全膀胱切除4例;死亡2例,其中1例死于心机梗死,另1例死于肿瘤广泛转移。结论双极等离子电切系统行TURBT治疗浅表性膀胱癌是一种安全有效的方法,但仍要防止闭孔神经反射的发生。
Objective To investigate the safety and efficacy of transurethral bipolar plasma tangential system in the treatment of bladder cancer. Methods 85 cases of bladder cancer were treated with transurethral resection of the bladder tumor (TURBT) by transurethral bipolar plasma tangential system from Gyrus Company in England. The tumor was excised from the cutting electrode to the deep muscularis, Cut off from the normal tumor tissue 1 cm range of tissue, intravesical instillation of pirarubicin after surgery. Results The operation time ranged from 10 to 52 minutes with an average of 23 minutes. Intraoperative closed-hole nerve reflex occurred in 19 cases, of which 2 cases of extraperitoneal perforation. Sixty-four patients were followed up for 3 to 72 months with an average of 21 months and 17 relapsed (3 relapsed between 6 and 12 months after operation, 9 relapsed between 1 and 2 years and 5 relapsed between 2 and 5 years) 8 cases of subtotal resection, partial resection of bladder in 5 cases, total cystectomy in 4 cases; 2 died, 1 case died of myocardial infarction, the other died of extensive tumor metastasis. Conclusions Bipolar plasma tangential excision system TURBT is a safe and effective method for the treatment of superficial bladder cancer, but it is still necessary to prevent the obstruction of obturator nerve reflex.