Wang T, Hong X, Wang X F
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Aug 18;52(4):632-636. doi: 10.19723/j.issn.1671-167X.2020.04.006.
To explore the clinical application value of using needle electrode in transurethral plasmakinetic resection of bladder tumor around ureteral orifice.
Retrospective analysis was performed on the clinical data of 16 cases who had bladder tumors around ureteral orifice and underwent transurethral resection using plasmakinetic needle electrode in Department of Urology, Peking University International Hospital from June 2015 to December 2019. There were nine cases with the tumor of one to two centimeters from the ureteral orifice. The rest of the seven cases had tumor that was within one centimeter from the ureteral orifice, including two cases whose ureteral orifice was invaded by the tumor. All the patients studied were diagnosed before surgery and contraindications were excluded. The plasmakinetic needle electrode was used to treat the tumor with en bloc resection, and all the excised tissue was sent for pathological examination. Intravesical chemotherapy and postoperative follow-ups were performed. Statistical analysis was performed on the operation time, the incidence of obturator nerve reflex, the peri-operative bleeding, the parameters of indwelling ureteral catheter or double-J stent, the incidence of postoperative hydronephrosis, the clinical stage of tumor, and the recurrence rate.
The operation was successfully completed for all the sixteen cases. The operation time was 16 to 57 minutes, with an average of (32.6±11.8) minutes. No obvious obturator nerve reflex and perioperative bleeding occurred in all the patients. Ureteral catheters were indwelled prior to the operation of tumor resection in seven cases. Four of the seven cases had the ureteral catheters remained while the rest three were replaced by double-J stent after surgery. Postoperative pathological analysis showed that all the tumors were urothelial carcinoma, including 9 cases of low grade and 7 cases of high grade. Pathological staging: 10 cases were in Ta stage, 5 cases in T1 stage, and 1 case in T2a stage. All tumor bases and lateral margins were negative. All the patients received 3-56 months, with an average of (26.0±18.1) months of follow-up. There was no case of upper urinary tract hydronephrosis or tumor recurrence.
The transurethral plasmakinetic resection of bladder tumor using needle electrode can realize en bloc tumor resection without obturator nerve reflex and reduce the risk of ureteral orifice injury. It is a safe and effective surgical method for treating bladder tumors around the ureteral orifice.
探讨针状电极在输尿管口周围膀胱肿瘤经尿道等离子体动力切除术中的临床应用价值。
回顾性分析2015年6月至2019年12月在北京大学国际医院泌尿外科采用等离子体动力针状电极对16例输尿管口周围膀胱肿瘤患者进行经尿道切除术的临床资料。其中肿瘤距输尿管口1～2厘米者9例，其余7例肿瘤距输尿管口1厘米以内，其中2例输尿管口被肿瘤侵犯。所有研究对象术前均已确诊并排除禁忌证。采用等离子体动力针状电极整块切除肿瘤，所有切除组织均送病理检查。术后进行膀胱灌注化疗及随访。对手术时间、闭孔神经反射发生率、术中出血情况、留置输尿管导管或双J支架的相关参数、术后肾积水发生率、肿瘤临床分期及复发率进行统计分析。
16例手术均顺利完成。手术时间为16～57分钟，平均（32.6±11.8）分钟。所有患者均未出现明显的闭孔神经反射及术中出血。7例患者在肿瘤切除术前留置了输尿管导管，其中4例术后保留输尿管导管，其余3例术后更换为双J支架。术后病理分析显示，所有肿瘤均为尿路上皮癌，其中低级别9例，高级别7例。病理分期：Ta期10例，T1期5例，T2a期1例。所有肿瘤基底及切缘均为阴性。所有患者随访3～56个月，平均（26.0±18.1）个月。无一例发生上尿路肾积水或肿瘤复发。
针状电极经尿道等离子体动力切除膀胱肿瘤可实现肿瘤整块切除，无闭孔神经反射，降低输尿管口损伤风险。是治疗输尿管口周围膀胱肿瘤安全有效的手术方法。
