经尿道钬激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术治疗表浅层膀胱癌的效果对比

经尿道钬激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术治疗表浅层

膀胱癌的效果对比

目的研究对比表浅层膀胱癌应用经尿道钬激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术治疗的效果。方法选取我院2015年5月～2017年5月收治的64例表浅层膀胱癌患者，根据计算机分组法将其分为对照组（n=32）和观察组（n=32）。对照组实施经尿道膀胱肿瘤电切术治疗，观察组实施经尿道钬激光膀胱肿瘤切除术治疗，分析比较两组患者的手术指标、住院时间、炎症因子水平、血清指标、并发症发生率等情况。结果观察组患者的肝细胞生长因子（HGF）、肿瘤特异性生长因子（TSGF）水平低于对照组，纤维蛋白原（Fib）水平高于对照组，差异有统计学意义（P＜0.05）。观察组的术中出血量少于对照组，且膀胱冲洗时间、尿管留置时间、住院时间短于对照组，差异有统计学意义（P＜0.05）。观察组的白细胞介素6（IL-6）、白细胞介素8（IL-8）、白细胞介素10（IL-10）、肿瘤坏死因子（TNF-α）水平低于对照组，差异有统计学意义（P＜0.05）。观察组的并发症发生率低于对照组，差异有统计学意义（P＜0.05）。结论经尿道钬激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术在表浅层膀胱癌的临床治疗中，前者手术指标明显优于后者，且前者既可改善血清指標及炎症因子水平，又可缩短患者住院时间，降低并发症发生率，治疗效果较高，值得临床推广应用。

[Abstract] Objective To study and compare the therapeutic effect of transurethral holmium laser resection of bladder tumor and transurethral resection of bladder tumor in the treatment of superficial bladder cancer. Methods A total of 64 superficial bladder cancer patients in our hospital from May 2015 to May 2017 were selected and divided into the control group （n=32）and the observation group （n=32）according to the computer grouping method. The control group was treated with transurethral resection of bladder tumor. The observation group was treated with transurethral holmium laser resection of bladder tumor. The operative parameters，length of stay，inflammatory factors，serum markers，and complications were analyzed and compared between the two groups. Results The level of HGF and TSGF of the observation group were lower than those of the control group，and the FIB of the observation group was higher than that of the control group，the difference was statistically significant （P＜0.05）. The intraoperative blood loss in the observation group was lower than that in the control group，and the bladder irrigation time，urinary catheter indwelling time，hospitalization in the observation group was shorter than that in the control group，the difference was statistically significant （P＜0.05）. The levels of IL-6，IL-8，TNF-α and IL-10 in the observation group were lower than those in the control group，the difference was statistically significant （P＜0.05）. The incidence of complications in the observation group was lower than that in the control group，and the difference was statistically significant （P＜0.05）. Conclusion Transurethral holmium laser resection of bladder tumor with transurethral resection of bladder tumor and transurethral resection of bladder tumor in the clinical treatment of superficial bladder cancer，the former is better than the latter，and the

former can improve the serum index and the level of inflammatory factors，shorten the time of hospitalization，reduce the incidence of complications and clinical treatment. The therapeutic effect is high，and it is worthy of clinical promotion and application.[Key words] Contrast；Superficial bladder cancer；Transurethral holmium laser resection of bladder tumor；Transurethral resection of bladder tumor；Therapeutic effect

膀胱癌属于临床最常见的一种泌尿系统恶性肿瘤，病灶出现于膀胱黏膜上，临床表现为血尿、膀胱刺激征、排尿困难、上尿路阻塞等，膀胱癌发病机制较为复杂，既有外在的环境因素，又有遗传因素的影响[1-2]。临床统计显示[3-5]，表浅层膀胱癌占膀胱肿瘤的70%以上。在临床治疗中，本病多采用手术治疗，而传统手术具有创伤大、出血多、术后恢复慢、复发率较高等特点，不利于患者病情的恢复。随着微创技术的进步，微创手术应用于表浅层膀胱癌患者临床治疗中，可有效减少术中出血量、降低并发症发生率，促使患者病情尽快康复[6-8]。目前，临床最常用的手术治疗方式有经尿道钬激光膀胱肿瘤切除术、经尿道膀胱腫瘤电切术，但不同的治疗方式所产生的效果不同。本研究选取我院收治的表浅层膀胱癌患者作为研究对象，分析对比表浅层膀胱癌应用经尿道钬激光膀胱肿瘤切除术与经尿道膀胱肿瘤电切术的治疗效果，现报道如下。

1资料与方法

1.1一般资料

选取我院2015年5月～2017年5月收治的64例表浅层膀胱癌患者，根据计算机分组法分为对照组与观察组，各32例。对照组中，男18例，女14例；年龄40～80岁，平均（60.5±10.4）岁；肿瘤直径0.6～5.6 cm，平均（3.1±0.8）cm；单发肿瘤22例，多发肿瘤10例；细胞癌分级：Ⅰ级16例，Ⅱ级10例，Ⅲ级6例。观察组中，男19例，女13例；年龄41～79岁，平均（61.2±11.1）岁；肿瘤直径0.5～5.5cm，平均（3.0±0.9）cm；单发肿瘤21例，多发肿瘤11例；细胞癌分级：Ⅰ级17例，Ⅱ级10例，Ⅲ级5例。两组患者的一般资料比较，差异无统计学意义（P>0.05），具有可比性。本研究经我院医学伦理委员会批准同意。诊断标准：符合中表浅层膀胱癌临床诊断标准，且经病理学检测与膀胱镜检查证实[9]。纳入标准：术前病理检查确诊者；患者及家属均了解本次研究方案，并与我院签署知情同意书者。排除标准：肝肾功能障碍者；严重心功能不全者；凝血功能异常者；依从性较差者；手术禁忌证者；血液系统疾病者；恶性肿瘤者[10]。

1.2方法

所有患者入院后，对其临床症状及体征进行检查，明确病情后，对照组实施经尿道膀胱肿瘤电切术治疗，术前应用生理盐水对膀胱实施半充盈状态，取膀胱截石位，实施硬膜外麻醉，设置电切功率为140 W，电凝功率为60 W。在连续灌洗电切镜下进入膀胱内，并对肿瘤的具体位置、大小、切除范围等进行观察，之后切除瘤体，直至肌肉层电凝瘤体周围的正常黏膜组织上[11]。手术后实施双