The Clinic Research Of Transurethral Partial Cystectomy In Treatment Of Bladder Tumor By 2μm Continuous Wave Laser

Objective To establish a new surgery method of transurethral partial cystectomy in treatment of bladder tumor by 2μm continuous wave laser;To analyze the clinical characteristics of this method and the histopathologic characteristics of bladder tumor's specimens and to observe the TNM staging.To observe the efficiency of 2μm laser on the edge of the surgery field;To summarize the change law of bladder tumor cells in irrigating solution after surgery;To obverse the leakage of fluid inner the bladder;To summarize and analyze the clinic characteristics of bladder tumor patients in follow-up periods after the surgery.Methods From April 2008 to April 2009,according to the established standard, we chose patients with bladder tumors treated by 2μm laser via transurethral under sacral block.We overview these following variables:operation characteristics,clinic curative effect,pathology staging of the tumor;To summarize the change of bladder tumor cells in irrigating solution after operation with cytology;To obverse the leakage of fluid inner the bladder by Transrectal Ultrasound or Transvaginal Ultrasound;To summarize and analyze the clinic characteristics of bladder tumor patients in follow-up periods after the surgery.Results All the patients were tolerated in the operation.The mean operative time was 5-12 min.Blood loss in the operation was minimal.No patient experienced an obturator nerve reflection or a hemorrhage after the operation.The tumor,submucosa and all muscular layers can be resected completely by 2μm continuous wave laser transurethral partial cystectomy.No tumor residual was deteced on the cutting edges.Pathologic staging can be judged correctly.5 times of bladder irrigation in all cases of partial cystectomy by 2μm continuous wave laser,can reduce the remnants of the bladder tumor cells effectively,lcase had urine leakage and lcase had peritoneum perforation inspected by Transrectal Ultrasound or Transvaginal Ultrasound.The follow-up periods were between 1 to 13 months,and the median period was 9months.There was no recurrence in situ.The survival rate is 100%.Conelusions(1)2μm continuous wave laser for the treatment of bladder tumor is a new safety and efficacy method.Due to the 2μm laser can completely excise the whole detrusor muscle layers of bladder,and precisely strip the muscle layer from the outer layer connective tissues,it can get the same clinical result as partial cystectomy.It not only can treatment the superficial bladder tumor efficiently, but also refer to part of invasion bladder tumor.(2) During 2μm laser partial cystectomy,the tumor and the whole bladder wall at its basal part could be excised completely to obtain a gross specimen.The pathologic staging can be judged correctly by these specimens.The sections of full-thickness of the bladder wall could be obtained during the pathological examination in order to determine pathological staging and diagnosis.It could be used to observe the therapeutic effects of operations on various grades of tumors and direct the subsequent treatment.(3) Using partial cystectomy by 2μm laser,can keep Integrity and less destroied of the tumor.After the surgery,5 times of bladder irrigation can reduce the remnants of the bladder tumor cells effectively,and lower the risk of the tumor cells spreading implantation.(4) Inspected by Transrectal Ultrasound or Transvaginal Ultrasound after operation,the integrity of the bladder wall can be keep finely.Bladder perforation was seldom.(5) Transurethral partial cystectomy by 2μm laser in treatment of bladder tumor.It can not only treat non-muscle-invasive bladder tumors efficiently,but also treat some types of muscle-invasive tumors of the bladder.It has minor influences on the patient's quality of life.It accords with the principle of evidence-based medicine.