微创医学

目的探讨术前24 h局麻下钬激光标识膀胱癌切缘在腹腔镜下膀胱部分切除术中的临床应用价值。方法选择局限性膀胱癌（T2期）患者12例，随机分为对照组和观察组，各6例，对照组单纯行腹腔镜下膀胱部分切除术，观察组于术前24 h局麻下钬激光标识膀胱癌切缘后行腹腔镜下膀胱部分切除术。对比分析两种术式治疗前后的疗效及预后。结果两组患者均手术成功，观察组可见钬激光汽化标识的膀胱壁出现特有的水肿带，无膀胱穿孔及继发出血等并发症，在腹腔镜下水肿带将肿瘤边缘的分界线标识清晰。两组手术时间［（60±12）min vs （45±10）min］、术中出血量［（20±5）mL vs （10±4）mL］、病变切除范围［（4.5±1.5）cm×（3.5±1.8）cm vs （4.0±1.6）cm×（3.0±1.6）cm］、切缘阳性率［25.0%（1例） vs 0.0%（0例）］、12个月复发率［50.0%（2例） vs 25.0%（1例）］比较，差异有统计学意义（P＜0.05）；而在术后漏尿、感染、术后6个月局部复发、远处转移方面，两组比较，差异无统计学意义（P＞0.05）。结论术前24 h局麻下钬激光标识膀胱癌切缘后行腹腔镜膀胱部分切除术具有创伤小、定位准确、减少肿瘤组织残留隐患的优点，并见清晰界线的特有水肿带指引，治疗安全有效。

ObjectiveTo investigate the clinical application value of holmium laser identification of bladder cancer resection margin in laparoscopic partial resection of bladder. Method12 cases of localized bladder cancer (T2 phase) were randomly divided into control group and observation group, 6 cases in each group.Patients of control group were treated with simple laparoscopic partial resection of the bladder;In the observation group,24 hours before surgery under local anesthesia holmium laser resection margin identification of bladder cancer and that treated with laparoscopic partial resection of bladder,to compare and analyze the curative effect and prognosis of two kinds of surgery before and after treatment. ResultTwo groups of patients were successfully operated;In the observation group, the bladder wall with holmium laser vaporization was found to have specific edema zone, no complications such as perforation of the bladder and secondary hemorrhage,the demarcation line of the tumor margin was clearly identified by edema zone under laparoscopy.Comparing with the time of surgery ［(60±12) min vs (45±10 min)］, the intraoperative bleeding volume ［(20±5) ml vs (10±4) ml］, the lesion resection range［ (4.5±1.5) cm × (3.5±1.8)cm vs (4.0±1.6)cm× (3.0±1.6)cm］cutting edge positive rate ［25.0% (1 cases) vs 0.0% (n=0)］, 12 months recurrence rate (50.0%)(2 patients) vs 25.0% (1 cases) of two groups of patients,the difference was statistically significant (P＜0.05).However,Comparing with postoperative urinary leakage, infection, local recurrence of 6 months after operation, distant metastasis of two groups of patients,the difference was not statistically significant (P＞0.05). ConclusionPreoperative 24 hours under local anesthesia holmium laser marking bladder cancer cut margin underwent laparoscopic partial bladder resection with less trauma, accurate positioning, advantages of reducing the risk of tumor tissue residue, and see the clear boundary of the characteristic edema with guidelines, the treatment is safe and effective.