| Background and ObjectiveBladder cancer is the commonest malignancy of the urinary tract. Incidence of bladder cancer ranked ninth in the malignant tumor. Common growth area of bladder cancer is bladder sidewall, followed by paries posterior bladder, trigonum vesica. Urothelial carcinoma is the most common tumor in the bladder cancer, accounting for more than 90%. According to the classification of tumor infiltration depth, superficial bladder cancer, namely the non-muscle-invasive bladder cancer(NMIBC), account for more than two-thirds of all the bladder cancer.Tumor is confined to mucous membrane layer(Ta) or submucosa(T1), has not yet been infringed muscle layer.The main purpose of the treatment of superficial bladder cancer is to remove the existing tumor lesions, prevent tumor recurrence and prevent recurrence of tumor progression. The clinical treatment of superficial bladder cancer is usually surgery combined intravesical chemotherapy. Surgical treatment are mainly Transurethral resection of bladder tumor(TURBT) and partial cystectomy, total cystectomy. TURBT surgery is often used for superficial bladder cancer, generally applicable to papillary urothelial neoplasm of low malignant potential, carcinoma in situ of primary surgical treatment, muscularis invasive bladder cancer with palliative symptomatic treatment. TURBT contraindicated for patients with severe urethral stricture. TURBT surgical incision does not exist and can be repeated. So for multifocal bladder cancer can be carried out in phases, and will not increase the difficulty of operation. The short-term outcomes of TURBT are promising, with an OS rate of 70 during 5 years of follow-up. TURBT principle is to use high temperature electric coagulation to cut tissues.The incision depth is difficult to grasp. it’s easy to have a bladder perforation, cause urinary extravasation, abdominal pain. TURBT is commonly remove the tumor layer by layer, it’s difficult to get the complete pathologic specimens. This is not conducive to subsequent pathological analysis. TURBT need to instillation of physiological saline during the operation. Water temperature increased with time during TURBT, and would damage the bladder mucosa, generate a large number of air bubbles, which increased the bladder pressure. TURBT is difficult to completely resected tumor, malignant tumor recurrence rate is higher. This kind of surgery may induce obturator nerve reflex, which will cause other complications.2 micron laser resection is clinically common minimally invasive surgery in recent years.It depend on semiconductor pump, with 2 micron wavelength of continuous laser for laser removal. The first advantage of 2 micron laser is a simultaneous vaporization and cutting, effectively avoiding the intraoperative bleeding. Visual operative field is clearer than TURBT. It’s suitable for elderly patients, and patients with other diseases merger. The second point, 2 micron laser penetration depth is about 0.3 cm, solidified layer is about 0.1 cm. This attribute avoid causing bladder mucosal necrosis, edema, bladder p erforation, urinary extravasation. The third point, the valid range of 2 micron laser is only 2 mm. The water can highly absorb the laser energy, which can effectively prevent water vaporize, reduce the speed of bladder temperature, pressure rise. Fourth, with 2 micron laser the size of the tumor resection is controllable. Surgery can complete remove of the tumor and its base. It is beneficial to tumor pathology examination and clinical stage.Immune function changes associated with the damaged degree of the body. In the aspect of anti-infection, IL- 6, IL- 10 and TNF- a immune factor plays a very important role. These immune factors can evaluate intraoperative damaged degree of the human body.So this research adopts 2 micron laser for bladder cancer res ection, and TURBT treatment as control group. Compare the clinical effect of two groups. Aims to provide reference for clinical treatment of superficial bladder cancer.MethodsThe patients with superficial bladder cancer in our hospital from 2014 January to 2015 January were divided into two groups according to random number table method, in which observation group(61 cases) underwent 2 micron continuouse wave laser resection operation when control group(46 cases) underwent transurethral resection. Compari sons of operation effect,changes of inflammation factors before and after operation, safety were conducted.ResultsOperation time and bleeding volume during operation in observation group were less than these in control group, the difference was statistically significant(P<0.05). Level of IL-6,IL-10,TNF-α were higher in two groups after treatment were than those before treatment, but IL-6, TNF-α levels in observation group after treatment less than those in control group, IL-10 levels was higher than that in control group, the difference was statistically significant(P<0.05). There were different degree complications in two groups after treatment including perforation of bladder, bladder irritation and obturator nerve reflex. The incidence of perforation of bladder and obturator nerve reflexof observation group was 3.28% and 0% which was lower than 17.39% and 13.04% of control group, the difference between the two groups was statistically significant(P<0.05).Conclusion2 micron continuouse wave laser resection in the treatment of superficial bladder cancer can improve clinical operation effect, reduce postoperative complication and have a slight influence on levels of inflammatory factors, it has an important reference value in clinical. |
PDF Full Text Request