Research On The Clinical Efficacy Of Non Muscle-invasive Bladder Cancer (NMIBC) By The Different Surgical Approach

Objective: To analyze the clinical efficacy of non muscle-invasive bladder canceramong partial cystectomy(PC), transurethral resection of bladder tumor(TURBT) andholmium laser resection(HOLBT), and explore the best operation way of the treatmentof non-muscle invasive bladder.Methods：A total of327primary patients with Non muscle-invasive bladder cancerwere treated in our department between2007and2009,of which216cases werefollowed and suit to compare. The patients were divided into three groups based ondifferent operation. Partial cystectomy group has62patients, including42males and20females,aged22-75years old, with a median age of63years. The TURBT Grouphas90patients, including68males and22females,aged20-82years old, with a medianage of65years. Holmium laser resection group consist of64cases, including48casesof males and16females,aged18-81years old, with a median age of61years.Bladdertumor number, size, preoperative pathological stage and grading was no significantdifference in the statistical analysis among the three groups, so data was statisticallycomparable. Based on comparing2-year recurrence cases,surgical time,blood loss,indwelling catheter time,hospital days and postoperative complications, analysis of theclinical efficacy of the three approaches. Surgical methods: Partial cystectomy groupmust resect2cm normal bladder wall around the tumor, as to tumor around the ureteralorifice within2cm we should cut certain end ureter and then replanted ureter,indwelling double J tube in the Ureter; suturing the bladder incision1-0absorbablesuture after soaking the operative field in distilled water for5min, indwelling Fr20-22 urethral catheter, irrigating bladder.Smaller tumors(＜1cm) can be resect en bloc in thegroup of TURBT. The specimen should contain a part of the underlying bladder wall;Larger tumors (＞1cm) should be resected separately in fractions, which include theexophytic part of tumor, the underlying bladder wall with the detrusor muscle, and theedges of the resection area.The specimens from different fractions must be referred tothe pathologist in separate contains. Postoperative indwelling Fr20-22catheter, thenbladder irrigation. For less than1cm tumor holmium laser direct gasification in theHol-TURBT group; For more than1cm tumor, firstly Holmium laser resect theexophytic part of tumor, Not only cut off the tumor blood supply to reduce bledding,helping to keep the tumor body integrity, but also facilitate clear pathology, and thenentire tumor bed and2cm away from the tumor edge were resected, Resection deep todeep muscular layer of the normal bladder wall was a must; An Fr20-22urethralcatheter was placed, then irrigating bladder. Intravesical treatment: instillation ofTHP(30mg+5%GS30ml) was irrigated in bladder through the catheterimmediately(within24H) after operation for40min(supine10min,left lateralposition10min, right lateral position10min,prone position10min).The intravesicalinstillation regimen was introduced as30mg THP weekly for7weeks, and then onceevery month for2years. The follow-up period in this study was2years. Forpostoperative surveillance, cystoscopy was performed every3months for the first2years and every6months thereafter to monitor the recurrence of bladdercancer.Follow-up strategy:The most common approach(AUA guidelines)to followpatients with NMIBC after TUR consists of urinalysis, BUS, and cystoscopy, andcytology every3mo for2yr. Statistical methods:Using SPSS13.0software for statisticalanalysis; comparation of the three groups uses analysis of variance; Between the twogroups using LSD-t test; Count data uses the chi-square test, and P＜0.05for thedifference was statistically significant. Results: Their2-year recurrence cases were37,19,21respectively amongTURBT,partial cystectomy and holmium laser resection, and the difference has nosignificance(χ2=2.072， P＞0.05）;The difference of bladder spasms cases among thethree groups was statistically significant,but the partial resection group was the mostsevere(χ2=4.494,P<0.05)TURBT group had six cases of bladder perforation,15cases ofobturator nerve reflex but can still be time to complete the operation. The other twogroups didn’t happen this complications. Not only did TURBT group and holmium lasergroup in operative time, indwelling catheter time, hospital days be shorter than thepartial resection group,but also have the advantage of less blood loss, faster recoveryand less pain.The difference was statistically significant (P＜0.001). As to the adversereactions occurred after the infusion of drug such as frequent urination, hematuria,Patients can be tolerated by reducing the drug dose and urine alkalinization. No casestopped infusion of drug due to adverse drug perfusion,so patients can complete theperfusion treatment on time.Conclusion：1)The difference of the2-year recurrence rate among TURBTpartial cystectomy andholmium laser resection has no significance2)The group of TURBT was prone to occur to bladder perforation and obturator nervereflex,and partial cystectomy was prone to occur to complications of bladder spasm.3)Not only did TURBT group and holmium laser group in operative time, indwellingcatheter time, hospital days be shorter than the partial resection group,but also have theadvantage of less blood loss, faster recovery, less pain.4)As to the adverse reaction occurred after the infusion of drug such as frequenturination, hematuria, Patients can be tolerated by reducing the drug dose and urinealkalinization. No case stopped infusion of drug due to side effect,so it does not affectthe course of conduct.