Clinical Study Of Trans-urethral Laser En-bloc And Resection In The Treatment Of Non-muscle Invasive Bladder Cancer

Background:Transurethral resection of bladder tumor is the first choice for the treatment of non-muscular invasive bladder cancer.With the wide application of laser,transurethral enucleation of bladder tumor has been carried out in many hospitals,but no study has explored the clinical application value of the two.Object:Clinical comparison of transurethral laser en-bloc resection of bladder tumor(EBRbt)and transurethral resection of bladder tumor(TURbt)in the treatment of non-invasive bladder cancer.Methods:Clinical data: Patients diagnosed with bladder cancer in the central theater general hospital of the people's liberation army from October 2016 to February 2018 were retrieved.Inclusion criteria: tumor diameter less than3cm;Imaging examination showed no tumor invasion in muscle layer,no lung metastasis,bone metastasis and peripheral lymph node enlargement(Cis,Ta and T1 stage tumor).Patients with recurrence,multiple bladder tumors and absolute contraindication on preoperative examination were excluded.Study indexes:(1)preoperative data: age,gender,KPS score,tumor diameter,location and TCM classification of patients in EBRbt group and TURbt group were collected respectively.(2)perioperative data: operation time,blood loss,incidence of obturator nerve reflex,incidence of bladder perforation,bladder irrigation time,removal of urinary catheter,and postoperative pathological staging;(3)postoperative follow-up data: cystoscopy and chest and abdomen CT were reviewed every 3 months in the outpatient department,and the follow-up time was 1 year to observe whether the tumor had recurrence or metastasis,and the location and time of recurrence and metastasis were recorded.Results:1.A total of 80 patients were enrolled in the study.Pathological diagnosis was non-muscular invasive bladder cancer,including 58 males and 22 females.There were 69 cases in T1G1 phase and 9 cases in T1G3 phase without Cis.2.Traditional chinese medcine classification: damp-heat accumulation type in 38 cases,blood stasis type in 18 cases,Yin deficiency in 24 cases of internal heat.3.There was no significant difference in operation time between the two groups(P=0.818);Compared with TUBRbt group,EBRbt group had significant differences in blood loss(P=0.000),incidence of obturator nerve reflex(P=00),incidence of bladder perforation(P=0.000),postoperative bladder irrigation time(P=0.000),indwelling catheter time(P=0.000),and length of hospital stay(P=0.000).4.Postoperative follow-up: at the third month of follow-up, no tumor recurrence was found in both groups;At the 6th month,1 case of bladder cancer recurred in the EBRbt group and 3 cases in the TURbt group(P>0.05).At the 12 th month,2 cases of bladder cancer recurred in the EBRbt group and 8 cases in the TURbt group(P<0.05).Conclusion:1.Compared with TURbt,EBRbt has the advantages of less bleeding,shorter hospitalization time,lower incidence of obturator nerve reflex and bladder perforation,and can reduce the recurrence rate of bladder cancer.2.Compared with blood stasis type and Yin deficiency type,the recurrence rate of damp-heat entrapment type bladder cancer is higher than that of other types.