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The Clinic Research of Transurethral Partial Cystectomy in Treatment of Bladder Tumor by 2μm Continuous Wave Laser

Author: WeiZhiTao
Tutor: HongBaoFa；YangYong
School: PLA Postgraduate Medical School
Course: Surgery
Keywords: Bladder tumor Laser treatment Partial nephrectomy Pathology Exfoliative cytology Complication
CLC: R737.14
Type: Master's thesis
Year: 2009
Downloads: 54
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Abstract

Objective: To design a partial cystectomy in 2μm laser transurethral surgical treatment of bladder tumors, analysis of the clinical features of partial cystectomy applications 2μm laser treatment of bladder tumors; analyzed 2μm Laser partial bladder transurethral resection received specimens histopathological characteristics of tumor pathological staging, follow up study of laser surgery on the bladder wall tissue morphology, dynamic changes in the characteristics of the postoperative histomorphological characteristics of changes in the amount of residual tumor cells; the observed postoperative bladder lavage off ; observed postoperative intravesical fluid extravasation; summary of the analysis of the characteristics of bladder cancer patients followed up. METHODS: April 2008 to April 2009, based on the inclusion criteria formulated by preoperative examination, select outpatient and hospitalization bladder urothelial cancer using transurethral 2μm laser partial cystectomy treatment. Analysis of surgical characteristics observed clinical efficacy; analysis of biopsy specimens obtained; pathological cytology method to observe the changes of tumor cells in the bladder lavage fluid given to patients after transrectal ultrasound (vaginal) to understand bladder fluid extravasation; summary of the patients were followed up for results to analyze the characteristics of bladder tumors in patients with postoperative follow-up time. Results: All patients in the caudal anesthesia tolerable transurethral 2μm laser partial cystectomy. 5-12 minutes of surgical time, intraoperative almost no bleeding, no obturator nerve reflex, postoperative nor hemorrhage; histopathological analysis confirmed the removal of the tumor: the tumor attached to the bladder mucosa, submucosa and muscularis complete resection, resection margin no residual cancer cells, specimens can clearly determine tumor stage; the overall residual amount of tumor cells in the bladder lavage low variation associated with bladder tumor diameter, and surgical methods, properly flushing method can effectively remove residual cancer cells; postoperative transrectal ultrasound (vaginal) found two cases of patients with bladder and bowel lacuna exists a hypoechoic shadow diagnosed with peritoneal perforation, pelvic urinary extravasation cases are given surgical drainage in the treatment of the remaining patients can effectively maintain the continuity of the bladder wall; were followed up for 1 to 13 months, an average of 7.4 months, no local recurrence. Follow-up of this group urothelial carcinoma patients were followed nearly 1-year survival rate of 100%, the better the quality of life, followed up with the rate. Conclusions: (1) the treatment of bladder tumor transurethral 2μm laser partial cystectomy is a safe and effective method. 2μm laser can do fine layered anatomy of the full thickness of the bladder wall, surgery in the loose connective tissue between the muscular layer and the outer layer of peel, so you can achieve the purpose of partial cystectomy. 2μm laser partial cystectomy not only can effectively treat invading the lamina propria of non-muscle invasive tumor invasion and local myometrial invasive tumors can be treated. This may opened up new avenues for the treatment of some of the invasive bladder tumor. (2) through the urethra 2μm laser partial cystectomy specimens obtained the full thickness of the wall of the bladder tumor and its attachment organization complete The resulting specimens can accurately determine the clinical stage of the tumor, and to guide subsequent treatment, postoperative wound healing . (3) the urethra 2μm laser bladder partial tumor resection, less destruction of tumor tissue, can maintain the integrity of the tumor, effectively reducing the residual tumor cells in bladder lavage. Postoperative mirror sheath bladder lavage, can effectively remove the residual tumor cells in the bladder to reduce the risk of the spread of tumor cells to grow through five consecutive times by cutting. (4) through postoperative rectum (vaginal) ultrasound confirmed: the treatment of bladder tumors by the urethra 2μm laser partial cystectomy, can effectively maintain the continuity of the bladder wall, and less prone to the phenomenon of bladder perforation. (5) Application transurethral 2μm laser partial cystectomy, whether it is for the treatment of non-invasive bladder tumor invasive bladder tumors are meaningful: a non-invasive bladder cancer patients surgery is safe and reliable, clear efficacy can be very good to develop in patients with individualized treatment programs to reduce unnecessary complications. Invasive bladder tumor patients satisfactory outcome, better quality of life, followed up with the high rate, before the implementation should be curative effect and prognosis objectively inform patients and their families to understand and actively cooperate with the patients choose to keep the bladder and normal urinary function willingness to be respected, to participate in the treatment decision-making process, in line with the principles of evidence-based medicine.

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