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目的:探讨应用等离子针状电极精准切除膀胱侧壁肿瘤的方法及效果。方法:52例膀胱肿瘤患者,肿瘤位于膀胱侧壁,应用等离子针状电极进行精准经尿道膀胱肿瘤切除,记录手术时间、有无诱发闭孔神经反射、有无穿孔、肿瘤病理分期及有无复发等。结果:所有患者均在硬脊膜外麻醉下顺利完成精准经尿道膀胱肿瘤切除,均未进行闭孔神经阻滞。切除侧壁肿瘤62枚,肿瘤大小0.5~4.0cm,平均(1.75±0.56)cm。单枚肿瘤切除时间1~25min,平均(11.6±5.7)min。术中均未发生闭孔神经反射,出血少,无膀胱穿孔等并发症,切除的肿瘤均获得完整病理分期:32%为pTa期,55%为pT1期,13%为pT2期。术后随访3~32个月,平均25.6个月,均未见原位肿瘤复发。结论:精准经尿道膀胱肿瘤切除能够完全消除闭孔神经反射,完整切除膀胱侧壁肿瘤,获取完整标本进行精确临床分期。精准经尿道膀胱肿瘤切除是未来膀胱癌精准治疗的重要环节。
Objective: To investigate the method and effect of precise excision of bladder tumor with plasma needle electrode. Methods: Fifty-two patients with bladder cancer were examined. The tumor was located on the side wall of the bladder. The plasma needle-shaped electrodes were used for accurate transurethral resection of bladder tumor. The time of operation, the obstruction of obturator nerve, the perforation, the tumor staging and the recurrence were recorded Wait. Results: All patients underwent successful transurethral resection of bladder tumor under epidural anesthesia. No obturator nerve block was performed. 62 resected side wall tumors, tumor size 0.5 ~ 4.0cm, an average of (1.75 ± 0.56) cm. Single tumor resection time 1 ~ 25min, with an average (11.6 ± 5.7) min. Intraoperative closed obturator nerve reflex did not occur, less bleeding, no bladder perforation and other complications, resected tumors were complete pathological staging: 32% of pTa period, 55% of pT1 period, 13% of pT2 period. The patients were followed up for 3 to 32 months, an average of 25.6 months, no recurrence of tumor in situ. Conclusion: Accurate transurethral resection of bladder tumor can completely obstruct obturator nerve reflex, complete excision of tumor of the bladder wall, obtaining complete specimen for accurate clinical staging. Precise transurethral resection of bladder tumor is an important part of accurate treatment of bladder cancer in the future.