Application of day surgery mode of transurethral en bloc resection of non-muscle-invasive bladder cancer via thulium fiber laser
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摘要: 目的 探讨光纤铥激光在膀胱肿瘤整块切除术日间手术模式中的应用及技术特点。方法 回顾性分析2020年1月—2021年12月采用光纤铥激光膀胱肿瘤整块切除术治疗非肌层浸润性膀胱肿瘤的344例患者的临床资料。术前通过膀胱镜检查明确肿瘤形态、位置、大小、数量；均行多参数磁共振成像(mpMRI)和VI-RADS评分。术中采用监护下麻醉管理技术(MAC)的经尿道光纤铥激光膀胱肿瘤整块切除术，术后给予心电血氧饱和度监护2 h。对术中出血、手术时间、膀胱冲洗时间、尿管留置时间、并发症及恢复情况进行评估。结果 手术时间2~16 min，平均9 min；术中基本无出血，无膀胱穿孔和闭孔神经反射；留置导尿管1~3 d；膀胱冲洗时间0.5~2.0 h。结论 在门诊通过泌尿专科及麻醉科评估筛选合适的患者，经充分术前准备以及严格的术后管理，行经尿道光纤铥激光膀胱肿瘤整块切除术的日间手术是安全可行的，能明显减少患者等待入院时间、住院时间、家属陪侍时间以及住院费用，提高了麻醉感受度，且疗效与住院手术相当。Abstract: Objective To investigate the technical characteristics and application of thulium fiber laser resection of bladder tumor in day surgery mode.Methods Clinical data of 344 patients with non-muscle-invasive bladder cancer (NMIBC) treated with thulium fiber laser resection of bladder tumor (TuRBT) from January 2020 to December 2021 were retrospectively reviewed. The tumor morphology, location, size, and number were defined by cystoscopy. Multi-parameter magnetic resonance imaging (mpMRI) and VI-RADS were scored. Transurethral thulium fiber laser resection of bladder tumor was performed using monitoring anesthesia care (MAC), and ECG oxygen saturation was monitored for 2 hours after operation. The intraoperative bleeding, operation time, bladder irrigation time, indwelling catheter time, complications, and recovery were evaluated.Results The operation time was 2-16 min, with an average of 9 min, and no bleeding, bladder perforation, or obturator nerve reflex was found during operation. The time of indwelling catheter was 1-3 days, and the bladder irrigation time was 0.5-2.0 hours.Conclusion Through the evaluation of urology and anesthesiology in outpatient department, the daytime operation of transurethral thulium fiber laser bladder tumor en bloc resection is safe and feasible after adequate preoperative preparation and strict postoperative management. It can significantly reduce the waiting time for admission, hospitalization time, family companion time and hospitalization expenses, improve the anesthetic sensitivity, and the curative effect is similar to that of inpatient surgery.
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表 1 膀胱肿瘤患者一般资料
例(%)，X±S 项目 数值 男/女/例 275/69 年龄/岁 61.6±9.8 肿瘤数目/个 1~4 肿瘤数目分组/例 单发 267 多发 77 肿瘤直径/mm 16.8±12.5 肿瘤直径≤10 mm 112(32.5) 肿瘤直径＞10 mm 232(67.5) 肿瘤位置 侧壁 210(61.1) 其他 134(38.9) 术后病理分期 Ta 86(19.9) T1 258(59.8) 
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表 2 日间手术和住院手术患者一般情况
项目 日间手术 住院手术 P值 住院时间/d 1.00 8.34±3.56 < 0.05 平均费用/元 6 136.49 11 342.79 < 0.05 注：住院手术数据来源山西医科大学第一医院运营科。
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[1] 马洪升, 戴燕. 日间手术治疗模式国内外发展简述[J]. 中国医院管理, 2012, 32(1): 47-48. doi: 10.3969/j.issn.1001-5329.2012.01.019
[2] 贺大林, 吴开杰, 范晋海. 肌层非浸润型膀胱肿瘤激光治疗的现状与展望[J]. 现代泌尿外科杂志, 2015, 20(6): 373-375. doi: 10.3969/j.issn.1009-8291.2015.06.002
[3] Gao X, Ren S, Xu C, et al. Thulium laser resection via a flexible cystoscope for recurrent non-muscle-invasive bladder cancer: initial clinical experience[J]. BJU, 2008, 102(9): 1115-1118. doi: 10.1111/j.1464-410X.2008.07814.x
[4] 魏亮, 王东文, 尹楠, 等. 激光助力经尿道膀胱肿瘤整块切除术的临床研究[J]. 临床泌尿外科杂志, 2017, 32(10): 760-763. doi: 10.13201/j.issn.1001-1420.2017.10.006
[5] Taratkin M, Azilgareeva C, Cacciamani GE, et al. Thulium fiber laser in urology: physics made simple[J]. Curr Opin Urol, 2022, 32(2): 166-172. doi: 10.1097/MOU.0000000000000967
[6] Khusid JA, Khargi R, Seiden B, et al. Thulium fiber laser utilization in urological surgery: A narrative review[J]. Investig Clin Urol, 2021, 62(2): 136-147. doi: 10.4111/icu.20200467
[7] Das S, Ghosh S. Monitored anesthesia care: An overview[J]. Jaesthesiol Clin Pharmacol, 2015, 31(1): 27-29. doi: 10.4103/0970-9185.150525
[8] Kawamata M. Future and Current Status of Monitored Anesthesia Care(MAC)in Japan: Preface and Comments[J]. Masui, 2015, 64(3): 234-235.
[9] Han S, Dong K, Shen M, et al. Observation and mechanism study of bladder wound healing after transurethral holmium laser resection of bladder tumor[J]. Lasers Med Sci, 2019, 34(6): 1217-1227. doi: 10.1007/s10103-018-02713-0
[10] Kramer MW, Abdelkawi IF, Wolters M, et al. Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer[J]. Minim Invasive Ther Allied Technol, 2014, 23(4): 206-213. doi: 10.3109/13645706.2014.880065
[11] 白云金, 蒲春晓, 韩平, 等. 经尿道膀胱肿瘤切除日间手术模式的可行性分析[J]. 现代泌尿外科杂志, 2014, 19(9): 577-579. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK201409011.htm
[12] Carlomagno N, Tammaro V, Scotti A, et al. Is day-surgery laparoscopic cholecystectomy contraindicated in the elderly? Results from a retrospective study and literature review[J]. Int J Surg, 2016, 33(1): 103-107.
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