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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 36 -40. doi: 10.3877/cma.j.issn.1674-3253.2024.01.007

临床研究

自制"钳举"辅助器在经尿道膀胱肿瘤整块剜除治疗非肌层浸润性膀胱癌的应用
王伟峰, 张军, 万建省, 刘四明, 邹源, 郑少秋, 郝继东, 廖国强, 龚华, 欧阳磊†()   
  1. 201318　上海健康医学院附属周浦医院
    201203　上海中医药大学研究生院
  • 收稿日期:2023-09-19 出版日期:2024-02-01
  • 通信作者: 欧阳磊
  • 基金资助:
    浦东新区卫生健康委员会卫生计生科研面上项目(PW2020A-29); 浦东新区卫生健康委员会学科建设项目(PWZzk2022-22)

The application of self-made "forceps lifting" auxiliary device for en-bloc resection of bladder tumor through urethra in the treatment of non-muscular invasive bladder cancer

Weifeng Wang, Jun Zhang, Jiansheng Wan, Siming Liu, Yuan Zou, Shaoqiu Zheng, Jidong Hao, Guoqiang Liao, Hua Gong, Lei OuYang†()   

  1. Department of Urology, Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital, Shanghai 201318, China
    Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
  • Received:2023-09-19 Published:2024-02-01
  • Corresponding author: Lei OuYang
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引用本文：

王伟峰, 张军, 万建省, 刘四明, 邹源, 郑少秋, 郝继东, 廖国强, 龚华, 欧阳磊. 自制"钳举"辅助器在经尿道膀胱肿瘤整块剜除治疗非肌层浸润性膀胱癌的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 36-40.

Weifeng Wang, Jun Zhang, Jiansheng Wan, Siming Liu, Yuan Zou, Shaoqiu Zheng, Jidong Hao, Guoqiang Liao, Hua Gong, Lei OuYang. The application of self-made "forceps lifting" auxiliary device for en-bloc resection of bladder tumor through urethra in the treatment of non-muscular invasive bladder cancer[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(01): 36-40.

目的

探讨自制"钳举"辅助器行经尿道膀胱肿瘤整块切除治疗非肌层浸润性膀胱癌的临床效果。

方法

回顾性分析2021年3月至2023年1月上海健康医学院附属周浦医院64例非肌层浸润性膀胱癌患者的临床资料，分普通组与改良组，各32例，普通组采用传统经尿道膀胱肿瘤钬激光整块剜除术，改良组采用自制"钳举"辅助器行经尿道膀胱肿瘤钬激光整块剜除术。比较两组患者手术时间、术中血红蛋白下降情况、手术并发症和肿瘤原位复发情况。

结果

所有患者手术顺利，改良组血红蛋白下降（5±3）g/L，膀胱穿孔率0%（0/32），肿瘤原位复发率3.13%（1/32），普通组血红蛋白下降（6±3）g/L，膀胱穿孔率9.38%（3/32），肿瘤原位复发率12.5%（4/32），两组比较差异无统计学意义（P>0.05）；改良组手术时间（19±7）min，短于普通组（25±8）min，差异有统计学意义（P=0.004）；改良组肿瘤基底部含有肌层组织者93.75%（30/32），明显多于普通组40.63%（13/32），差异有统计学意义（P<0.001）。

结论

自制"钳举"辅助器行经尿道膀胱肿瘤钬激光整块剜除术治疗非肌层浸润性膀胱癌，与普通经尿道膀胱肿瘤钬激光整块剜除术具有同样少的手术并发症，安全可靠，因其可以清晰且稳定暴露肿瘤基底，手术时间更短，并可更多地获得肿瘤基底部的肌层组织，有利于肿瘤病理检查。该技术利用现有设备自制，操作简单，值得临床推广。

关键词: 膀胱肿瘤, 器械辅助, 经尿道膀胱肿瘤整块剜除术
Objective

To explore the clinical effect of self-made "forceps lifting" auxiliary device for transurethral bladder tumor en-bloc resection in the treatment of non-muscle invasive bladder cancer.

Methods

The clinical data of 64 cases of non-muscle invasive bladder cancer in Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital from March 2021 to January 2023 were retrospectively analyzed. They were divided into general group and improved group, 32 cases in each group. For enucleation, the improved group used a self-made "forceps lifting" auxiliary device for transurethral en-bloc enucleation of bladder tumors with holmium laser, the general group underwent traditional transurethral holmium laser en-bloc enucleation of bladder tumors. The operation time, intraoperative hemoglobin decrease, surgical complications and tumor recurrence were compared between the two groups.

Results

The operations of all patients went smoothly. The hemoglobin in the improved group decreased by (5±3) g/L, the probability of bladder perforation was 0%(0/32), the tumor recurrence rate in situ was 3.13%(1/32), and the hemoglobin in the general group decreased (6±3) g/L, the probability of bladder perforation was 9.38%(3/32), and the tumor recurrence rate in situ was 12.5%(4/32), there was no significant difference between the two groups (P>0.05). The operation time of the improved group was (19±7) min, shorter than the general group [(25±8) min](P=0.004); the number of people with muscular layer tissue in the tumor base of the improved group accounted for 93.75%, which was significantly more than that of the general group, which was 40.63% (P<0.001).

Conclusions

The holmium laser enuclear enucleation of transurethral bladder tumors treated with self-made "forceps lifting" auxiliary device has the same fewer surgical complications as general en bloc holmium laser enucleation of transurethral bladder tumors, and is safe. Because it can clearly and stably expose the tumor base, the operation time is shorter, and more muscle tissue at the base of the tumor can be obtained, which is conducive to tumor pathological detection. The technology is self-made with existing equipment, easy to operate, and worthy of clinical promotion.

Key words: Bladder tumor, Instrumental assistance, En-bloc resection of bladder tumor
表1 两组非肌层浸润性膀胱癌患者一般情况比较
组别 例数 性别(例) 年龄[岁，(±s)] 肿瘤数目(例) 最大肿瘤直径[cm，(±s)] 肿瘤位置(例)
男 女 单发 多发 部分及全部侧壁 三角区及后壁
普通组 32 24 8 66±8 22 10 2.3±1.1 7 25
改良组 32 25 7 69±7 20 12 2.4±1.1 9 23
统计值   χ2=0.087 t=0.375 χ2=0.277 t=0.603 χ2=0.333
P值   0.768 0.625 0.599 0.209 0.564
图1 改良经尿道膀胱肿瘤钬激光整块剜除术手术关键步骤注：图a示4 F取石钳（蓝箭头所指）和6 F双J管推管（红箭头所指）在6点凹槽处进入内鞘；图b~d示在瘤体旁约1 cm标记，钳夹标记点处正常黏膜上提形成张力进行激光切割，蓝箭头示取石钳，红箭头示激光光纤；图e~g示取石钳钳夹上提黏膜形成张力，在钬激光爆破力作用下，显露膀胱浅、深肌层平面，沿该平面拓展推进，整块切除瘤体（蓝箭头示取石钳，红箭头示激光光纤）；图h示切下的肿瘤组织由取石钳（蓝箭头所指）钳夹经电切镜鞘（红箭头所指）拖取出体外
表2 两组非肌层浸润性膀胱癌患者术中及术后情况比较
组别 例数 手术时间[min，(±s)] 血红蛋白下降值[g/L，(±s)] 膀胱穿孔率[例(%)] 肿瘤浅肌层完整情况[例(%)] 肿瘤原位复发率[例(%)]
无 有 无 有
普通组 32 25±8 6±3 29（90.62） 3（9.38） 13（40.63） 28（87.50） 4（12.50）
改良组 32 19±7 5±3 32（100.00） 0（0.00） 30（93.75） 31（96.87） 1（3.13）
统计值   t=8.242 t=2.148 - χ2=40.966 -
P值   0.004 0.143 0.238a <0.001 0.355a
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