CAJ | 학술논문

目的比较窄谱光成像(NBI)辅助钬激光与经尿道膀胱肿瘤切除术(TURBt)治疗非肌层浸润性膀胱尿路上皮癌(NMIBC)的1年复发风险,评价NBI辅助钬激光治疗NMIBC的临床应用价值.方法自2013年2月至2014年2月,将山东大学第二医院泌尿外科初步诊断为原发或复发膀胱肿瘤的209例患者按照简单随机化对照研究方法,分为NBI辅助钬激光组(NBI-HoLRBt)和经尿道膀胱肿瘤切除组(WLI-TURBt).NBI-HoLRBt组分别行普通白光(WLI)和NBI膀胱镜检查,然后在WLI下完成所有肿瘤及可疑病变的钬激光切除和活体组织检查,NBI下钬激光切除仅限于只在NBI下发现的病变.切除完成后,再用NBI膀胱镜检查所有切除区域,最终确定是否有肿瘤残留.WLI-TURBt组只用WLI膀胱镜检查,然后在WLI下完成TURBt和活检.术后均行常规灌注治疗.病理学诊断NMIBC患者178例纳入随访,其中NBI-HoLRBt组86例,WLI-TURBt组92例.比较两组在3个月及1年复发率的不同.结果 NBI-HoLRBt组在3个月及1年肿瘤复发率上要明显优于WLI-TURBt组[5.81％ (5/86)比18.48％(17/92),18.60％ (16/86)比38.04％(35/92),均P＜0.05].NBI-HoLRBt组在原位复发方面要明显优于WLI-TURBt组[2.33％ (2/86)比14.13％ (13/92),P＜0.05].结论 NBI辅助钬激光治疗非肌层浸润性膀胱尿路上皮癌能降低NMIBC 3个月及1年的肿瘤复发率,是治疗NMIBC的一种理想手术方法.
목적 비교착보광성상(NBI)보조화격광여경뇨도방광종류절제술(TURBt)치료비기층침윤성방광뇨로상피암(NMIBC)적1년복발풍험,평개NBI보조화격광치료NMIBC적림상응용개치.방법 자2013년2월지2014년2월,장산동대학제이의원비뇨외과초보진단위원발혹복발방광종류적209례환자안조간단수궤화대조연구방법,분위NBI보조화격광조(NBI-HoLRBt)화경뇨도방광종류절제조(WLI-TURBt).NBI-HoLRBt조분별행보통백광(WLI)화NBI방광경검사,연후재WLI하완성소유종류급가의병변적화격광절제화활체조직검사,NBI하화격광절제부한우지재NBI하발현적병변.절제완성후,재용NBI방광경검사소유절제구역,최종학정시부유종류잔류.WLI-TURBt조지용WLI방광경검사,연후재WLI하완성TURBt화활검.술후균행상규관주치료.병이학진단NMIBC환자178례납입수방,기중NBI-HoLRBt조86례,WLI-TURBt조92례.비교량조재3개월급1년복발솔적불동.결과 NBI-HoLRBt조재3개월급1년종류복발솔상요명현우우WLI-TURBt조[5.81％ (5/86)비18.48％(17/92),18.60％ (16/86)비38.04％(35/92),균P＜0.05].NBI-HoLRBt조재원위복발방면요명현우우WLI-TURBt조[2.33％ (2/86)비14.13％ (13/92),P＜0.05].결론 NBI보조화격광치료비기층침윤성방광뇨로상피암능강저NMIBC 3개월급1년적종류복발솔,시치료NMIBC적일충이상수술방법.
Objective To compare the differential effects of narrow band imaging (NBI)-assisted holmium laser with transurethral resection on the 1-year recurrence rate of non-muscle invasive bladder cancer (NMIBC),and to evaluate the clinical values of NBI-assisted holmium laser resection for NMIBC (NBI-HoLRBt).Methods During the period of February 2013 to February 2014,178 cases of NMIBC were randomly divided into NBI-HoLRBt group and white light imaging (WLI) assisted transurethral resection of bladder tumor (WLI-TURBt) group.In NBI-HoLRBt,all suspicious lesion identified by either WLI or NBI were resected with WLI and in NBI mode for lesion only visible with NBI.At the end of the procedure,a NBI cystoscopic examination was performed to assess the margins of the resection areas and to identify eventual residual lesions.In WLI-TURBt group,only WLI and TURBt were applied.All patients underwent routine follow-up with WLI and NBI cystoscopy supplemented with cytology every 3 month.The recurrence risk of patients with NMIBC subjected to either NBI-HoLRBt or WLI-TURBt was compared at 3 and 12 month.Results The 3-month and 1-year recurrence rate was 18.48％ (17/92) and 38.04％ (35/92) respectively in the WLI-TURBt group,it was 5.81％ (5/86) and 18.60％ (16/86) in the NBI-HoLRBt group (both P ＜ 0.05).In addition,the in situ recurrence rate was less in the NBI-HoLRBt than WLI-TURBt group (2.33％ vs 14.13％,P ＜ 0.05).Conclusion NBI-assisted holmium laser resection of bladder tumor can reduce the 3-month and 1-year recurrence risk of NMIBC and should be considered a valuable clinical therapeutic method for NMIBC.