CAJ | 학술논문

目的探讨经尿道2 μm激光膀胱部分切除术应用于膀胱黏膜下占位性病变的诊断和治疗特点.方法 2009年8月至2010年12月,选取解放军总医院门诊初诊为膀胱黏膜下占位性病变但病理结果不明确的9例患者.膀胱镜检提示肿块直径1.5～2.5 cm.应用经尿道2μm激光膀胱部分切除术切除肿物.术中用2 μm激光沿肿瘤周围全层切开膀胱壁,在肌层与外层结缔组织之间剥离整块膀胱壁,完整切除肿块及其基底部膀胱全肌层标本送病理检查.手术实施过程,观察术中出血情况,记录术中及术后并发症,术后病理诊断结果及临床随诊情况.结果全部患者手术过程顺利,手术时间25～47 min,平均36.4 min；术中出血量极少或几乎不出血,无闭孔神经反射,术后无继发出血患者.全部患者术后获得明确病理诊断:平滑肌瘤3例、嗜铬细胞瘤3例,子宫内膜异位症1例、肺癌膀胱转移瘤2例.结论经尿道2 μm激光膀胱部分切除术应用于膀胱黏膜下占位性病变的诊断和治疗,方法有效、安全.患者可以在避免更大痛苦的基础上获得明确病理诊断,对部分肿瘤达到微创治疗的目的.
목적 탐토경뇨도2 μm격광방광부분절제술응용우방광점막하점위성병변적진단화치료특점.방법 2009년8월지2010년12월,선취해방군총의원문진초진위방광점막하점위성병변단병리결과불명학적9례환자.방광경검제시종괴직경1.5～2.5 cm.응용경뇨도2μm격광방광부분절제술절제종물.술중용2 μm격광연종류주위전층절개방광벽,재기층여외층결체조직지간박리정괴방광벽,완정절제종괴급기기저부방광전기층표본송병리검사.수술실시과정,관찰술중출혈정황,기록술중급술후병발증,술후병리진단결과급림상수진정황.결과 전부환자수술과정순리,수술시간25～47 min,평균36.4 min；술중출혈량겁소혹궤호불출혈,무폐공신경반사,술후무계발출혈환자.전부환자술후획득명학병리진단:평활기류3례、기락세포류3례,자궁내막이위증1례、폐암방광전이류2례.결론 경뇨도2 μm격광방광부분절제술응용우방광점막하점위성병변적진단화치료,방법유효、안전.환자가이재피면경대통고적기출상획득명학병리진단,대부분종류체도미창치료적목적.
Objective To investigate the characteristics of transurethral partial cystectomy with a 2 μm laser in diagnosis and treatment for the bladder submucosal lesions in adults.Methods Nine patients with suspected pathological diagnosed bladder submucosal lesions in out-patient department were diagnosed and treated transurethral with a 2 μm laser under sacral block between August 2009 and December 2010.The diameters of tumors were 1.5-2.5 cm.A 2 μm laser was used to incise the full-thickness bladder wall around the tumors. The entire bladder wall was peeled between tbe detrusor muscle layer and outer connective tissues.Tumors with baldder wall at the base were removed together and sent for pathological examination. The surgical procedures, intraoperative hemorrhage, intraoperative and postoperative complications were observed,pathological diagnosis and postoperative follow-up were performed.Results All operations were successful. Mean operative time was 36.4 minutes (range 25 to 47 minutes),periopcrative blood loss was minimal.There was no obturator nerve reflection and no hemorrhage detected after surgery.Postoperative pathological diagnosis included leiomyoma in 3 cases,pheochromocytoma in 3 cases,endometriosis in 1 case and metastatic bladder cancer in 2 cases.Conclusions Transurethral partial cystectomy with a 2 μm laser can diagnose and treat bladder submucosal lesions. The procedures are effective and safe.Patients could get accurate pathological diagnosis without further painful and some bladder tumors can be treated by minimally invasive surgery.