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目的探讨在门诊局麻下经尿道膀胱软镜联合2μm激光治疗非肌层浸润性膀胱癌的可行性、安全性和疗效性。方法局麻下经尿道膀胱软镜联合德国生产的RevoLix 2μm激光手术系统治疗非肌层浸润性膀胱癌32例:男性21例,女性11例;单发肿瘤27例,多发肿瘤5例;肿瘤基底直径0.5~2.5cm,术后病理证实为乳头状瘤4例、低度恶性潜能移行细胞乳头状瘤5例、低级别移行细胞癌21例、高级别移行细胞癌2例。观察术中出血情况、手术时间、安全性及舒适度,术后留置尿管时间以及随访1年的复发率。结果 32例患者均在门诊行局麻手术,术中均能耐受手术疼痛,无需转换麻醉方式及手术方式,术后即刻疼痛评分为1(0~3)分,手术时间(9.88±2.17)min,术中出血(5.56±2.20)mL,术中均无闭孔神经反射、膀胱穿孔、尿外渗及水中毒。术中所有患者均无明显出血,其中25例患者因术中肿瘤基底较小且无明显疼痛,故术后未留置导尿管,其余7例因肿瘤基底较大,术后留置尿管1~3d;术后随访12个月,5例复发,复发率15.63%。结论门诊局麻下膀胱软镜联合2μm激光治疗非肌层浸润性膀胱癌是可行、有效和安全的,其具有疼痛能耐受、手术时间短、术中出血少、留置导尿管时间短及无需住院等优点,尤其适用于、肿瘤基底直径小于2cm的女性患者或高危且有麻醉禁忌症者,但对其长远疗效还需进一步观察。
Objective To investigate the feasibility, safety and curative effect of transurethral bladder soft-lens combined with 2μm laser in the treatment of non-muscle invasive bladder cancer under local anesthesia. Methods Twenty-two cases of non-muscle invasive bladder cancer were treated with transvaginal bladder soft-mirror combined with German-made RevoLix 2μm laser surgical system under local anesthesia: 21 males and 11 females; 27 single tumors and 5 multiple tumors; The diameter of 0.5 ~ 2.5cm, postoperative pathology confirmed as papilloma in 4 cases, 5 cases of low grade malignant potential transitional cell papilloma, 21 cases of low grade transitional cell carcinoma and 2 cases of high grade transitional cell carcinoma. Intraoperative bleeding, operation time, safety and comfort, duration of postoperative catheterization and follow-up of 1-year follow-up were observed. Results All the 32 patients underwent local anesthesia in the outpatient department. All the patients were able to tolerate the operation pain without conversion of anesthesia and operation mode. Immediate pain score was 1 (0-3) and operation time (9.88 ± 2.17) min, intraoperative bleeding (5.56 ± 2.20) mL, no obturator nerve reflex, bladder perforation, urinary extravasation and water poisoning. All patients had no obvious hemorrhage in operation. Twenty-five of the patients had small tumor base and no obvious pain. Therefore, no catheter was placed in the postoperative period. The remaining seven patients had large basement of the tumor, The patients were followed up for 12 months and 5 patients relapsed with a recurrence rate of 15.63%. Conclusions It is feasible, effective and safe to treat the non-muscle invasive bladder cancer with out-site local anesthesia with bladder soft-lens combined with 2μm laser. It has the advantages of pain tolerability, short operative time, less intraoperative bleeding, shorter indwelling catheter and No hospitalization and other advantages, especially for female patients with tumor base diameter less than 2cm or those who are at high risk and contraindication of anesthesia, but its long-term efficacy needs further observation.