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目的对经尿道膀胱肿瘤切除专用手术刀具治疗浅表性膀胱肿瘤进行临床应用评价。方法在传统电切刀的远端添加保护襻组成膀胱肿瘤切除专用手术刀具。使用该种手术刀具治疗浅表性膀胱肿瘤48例,使用方法与普通电切刀近似。男26例,女22例。年龄23~76岁,平均43岁。肿瘤分期Tis者1例,T0~T1者47例。肿瘤分级G1~G2者36例,G3~G4者12例。瘤体直径0.5~8.0 cm。肿瘤位于膀胱顶部4例,左侧壁11例,右侧壁9例,前壁4例,后壁13例,颈部7例。肿瘤单发31例,多发17例。术后常规卡介苗膀胱灌注1年,每3个月行膀胱镜检查1次。结果48例平均手术时间(23±10)m in。术中18例(37.5%)发生闭孔神经反射,未出现膀胱穿孔病例;无瘤体后部的正常膀胱黏膜误切。46例术后随访1年,14例复发,均为远位新生膀胱肿瘤,术后3个月时发现1例,4~6个月时3例,7~9个月时6例,10~12个月时4例。结论使用该专用手术刀具治疗浅表性膀胱肿瘤容易控制切除深度,可最大限度地避免膀胱穿孔,并可保护大体积肿瘤后部盲区的正常黏膜以免误切。
Objective To evaluate the clinical application of transurethral resection of bladder tumor for surgical treatment of superficial bladder tumor. Methods In the traditional electric knife to add protection distal 襻 bladder tumor resection dedicated surgical tools. 48 cases of superficial bladder tumor were treated with this type of surgical tool. The method of application was similar to that of ordinary electric knife. 26 males and 22 females. Age 23 to 76 years old, average 43 years old. One patient had Tis in tumor stage and 47 patients had T0 ~ T1. Tumor grade G1 ~ G2 in 36 cases, G3 ~ G4 in 12 cases. Tumor diameter 0.5 ~ 8.0 cm. The tumor was located at the top of the bladder in 4 cases, 11 in the left and 9 in the right, 4 in the anterior wall, 13 in the posterior wall, and 7 in the neck. Tumor in 31 cases, multiple in 17 cases. Conventional BCG bladder perfusion for 1 year, every 3 months underwent cystoscopy 1. Results The average operation time of 48 cases was (23 ± 10) m in. Intraoperative 18 cases (37.5%) obturator nerve reflex did not appear cases of bladder perforation; tumor-free posterior normal bladder mucosa false-cut. 46 cases were followed up for 1 year and 14 cases were recurrent, all of which were distant neoplasms. One case was found at 3 months after operation, 3 cases at 4 ~ 6 months, 6 cases at 7 ~ 9 months, 4 cases at 12 months. Conclusion The use of the special surgical tool for the treatment of superficial bladder tumors is easy to control the depth of resection, which can avoid the bladder perforation to the maximum extent and protect the normal mucosa in the blind area behind the large volume of the tumor from being wrongly cut.