Struck J P, Karl A, Schwentner C, Herrmann T R W, Kramer M W
Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland.
Urologe A. 2018 Jun;57(6):665-672. doi: 10.1007/s00120-018-0625-3.
Modifications in resection techniques may overcome obvious limitations of conventionally performed transurethral resection (e. g., tumor fragmentation) of bladder tumors or provide an easier patient treatment algorithm (e. g., tumor vaporization).
The present review article summarizes the current literature in terms of en bloc resection techniques, histopathological quality, complication rates, and oncological outcomes.
A separate data search was performed for en bloc resection (ERBT, n = 27) and vaporization (n = 15) of bladder tumors.
In most cases, ERBT is performed in a circumferential fashion. Alternatively, ERBT may be performed by undermining the tumor base via antegrade application of short energy impulses. Based on high rates of detrusor in specimens of ERBT (90-100%), a better histopathological quality is assumed. Significant differences in perioperative complication rates have not been observed, although obturator-nerve-based bladder perforations are not seen when laser energy is used. There is a nonstatistically significant trend towards lower recurrence rates in ERBT groups. Tumor vaporization may provide a less invasive technique for older patients with recurrences of low-risk bladder cancer. It can be performed in an outpatient setting.
ERBT may provide better histopathological quality. Tumor vaporization is performed in health care systems where reimbursement is adequate.
切除技术的改进可能克服传统经尿道膀胱肿瘤切除术（例如肿瘤破碎）的明显局限性，或提供更简便的患者治疗方案（例如肿瘤汽化）。
本综述文章从整块切除技术、组织病理学质量、并发症发生率和肿瘤学结局方面总结当前文献。
分别对膀胱肿瘤的整块切除（整块切除经尿道膀胱肿瘤切除术，n = 27）和汽化（n = 15）进行数据检索。
在大多数情况下，整块切除经尿道膀胱肿瘤切除术以环形方式进行。另外，可通过顺行施加短能量脉冲破坏肿瘤基底部来进行整块切除经尿道膀胱肿瘤切除术。基于整块切除经尿道膀胱肿瘤切除术标本中高比例的逼尿肌（90 - 100%），推测其组织病理学质量更好。尽管使用激光能量时未观察到基于闭孔神经的膀胱穿孔，但围手术期并发症发生率未观察到显著差异。整块切除经尿道膀胱肿瘤切除术组的复发率有降低趋势，但无统计学意义。肿瘤汽化对于老年低危膀胱癌复发患者可能是一种侵入性较小的技术。它可在门诊进行。
整块切除经尿道膀胱肿瘤切除术可能提供更好的组织病理学质量。在报销充足的医疗保健系统中可进行肿瘤汽化。
