Hermann Gregers G, Mogensen Karin, Lindvold Lars R, Haak Christina S, Haedersdal Merete
Department of Urology, Bispebjerg/Frederiksberg Hospital, Copenhagen University, Ndr. Fasan vej 57, DK-2000, Frederiksberg.
Centre for Nuclear Technologies (Nutech), Technical University of Denmark (DTU), DK-4000 Roskilde, Denmark.
Lasers Surg Med. 2015 Oct;47(8):620-5. doi: 10.1002/lsm.22402. Epub 2015 Sep 16.
Frequent recurrence of non-muscle invasive bladder tumours (NMIBC) requiring transurethral resection of bladder tumour (TUR-BT) and lifelong monitoring makes the lifetime cost per patient the highest of all cancers. A new method is proposed for the removal of low grade NMIBCs in an office-based setting, without the need for sedation and pain control and where the patient can leave immediately after treatment.
STUDY DESIGN/PATIENTS AND METHODS: An in vitro model was developed to examine the dose/response relationship between laser power, treatment time, and distance between laser fibre and target, using a 980 nm diode laser and chicken meat. The relationship between depth and extent of tissue destruction and the laser settings was measured using microscopy and non-parametric statistical analysis. A patient with low grade stage Ta tumour and multiple comorbidity, and therefore not fit for general anaesthesia, had a tumour devascularised using the laser at the tumour base, in the outpatient department. The tumour was left in the bladder.
In the in vitro model, depth of tissue destruction increased with laser illumination up to 30 seconds, where median depth was 4.1 mm. With longer illumination the tissue destruction levelled off. The width of tissue destruction was 2-3 mm independent of laser illumination time. The in vivo laser treatments devascularised the tumour, which was later shed from the mucosa and passed out with the urine in the days following treatment. Pain score was 0 on a visual log scale (0-10). The tumour had completely disappeared two weeks after treatment.
This diode laser technique may provide almost pain-free office-based treatment of low grade urothelial cancer using flexible cystoscopes in conscious patients. A prospective randomised study will be scheduled to compare the technique with standard TUR-BT in the operating theatre.
非肌层浸润性膀胱肿瘤（NMIBC）频繁复发，需要经尿道膀胱肿瘤切除术（TUR - BT）及终身监测，这使得每位患者的终身成本成为所有癌症中最高的。本文提出一种新方法，可在门诊环境中切除低级别NMIBC，无需镇静和疼痛控制，且患者治疗后可立即离开。
研究设计/患者与方法：利用980纳米二极管激光和鸡肉建立体外模型，以研究激光功率、治疗时间和激光光纤与靶点之间距离的剂量/反应关系。使用显微镜和非参数统计分析测量组织破坏深度和范围与激光设置之间的关系。一名患有低级别Ta期肿瘤且合并多种疾病、因此不适合全身麻醉的患者，在门诊通过激光使肿瘤基底部血管闭塞。肿瘤留在膀胱内。
在体外模型中，组织破坏深度随激光照射时间增加，直至30秒时达到中位数深度4.1毫米。照射时间更长时，组织破坏程度趋于平稳。组织破坏宽度为2 - 3毫米，与激光照射时间无关。体内激光治疗使肿瘤血管闭塞，随后肿瘤从黏膜脱落，并在治疗后的几天内随尿液排出。视觉模拟评分（0 - 10）的疼痛评分为0分。治疗两周后肿瘤完全消失。
这种二极管激光技术可能为清醒患者使用软性膀胱镜在门诊几乎无痛地治疗低级别尿路上皮癌。将安排一项前瞻性随机研究，以比较该技术与手术室标准TUR - BT的效果。
