Feasibility And Efficacy Of Bladder Tumor Of Endoscopi Submucosal Dissection (BT-ESD) Of Non-muscle Invasive Bladder Cancer

Objective:To investigate the feasibility and efficacy of Bladder tumor of endoscopi submucosal dissection(BT-ESD)in the minimally invasive treatment of non-muscle invasive bladder tumors.Methods: The clinical data of patients with non-muscle invasive bladder tumors who underwent surgical treatment from Department of Urology,Yijishan Hospital,Wannan Medical College from February 2016 to February 2017 were selected.From the number of bladder tumors,tumor diameter range,cystoscopy biopsy staging for preoperative evaluation.Patients with comparability were included and divided into TURBT group,BT-ESD learning group and after BT-ESD learing group according to the operation method and surgeon's surgical cases.In order to avoid the influence of learning curve on the statistical data,the patients with BT-ESD were divided into the first 15 cases of follow-up and the follow-up case separately.The first 15 cases of chief surgeons were included in the BT-ESD learning group Inclusion in BT-ESD group A,the remaining surgical patients classified as BT-ESD study group included BT-ESD B group,all TURBT patients were included in TURBT group.The size and number of tumor lesions,duration of operation,bladder irrigation time,urinary catheter retention time,intraoperative blood loss,postoperative hospital stay,operation-related complications and 1-year tumor recurrence were recorded.The resulting clinical data for statistical analysis.Results: Clinical data of 121 patients with bladder cancer who met the inclusion criteria were analyzed,including 89 males and 32 females,with a mean age of 63 years ranging from 24 to 85 years.Among them,82 patients underwent TURBT as the TURBT group,The first 15 BT-ESD patients were treated as BT-ESD Group A(BT-ESD study group)and the remaining 24 patients as BT-ESD Group B(after BT-ESD study group).Three groups in gender,age and other general conditions were not statistically significant(P>0.05).The duration of operation was statistically significant(P<0.05)in TURBT group(48.84±28.15min),BT-ESD A group(74.33±24.78min)and BT-ESD B group(52.92±14.81min);There was no significant statistical difference in preoperative hemoglobin between TURBT group(125.45±11.58g/l),BT-ESD group A(126.87±16.88g/l)and BT-ESD group B(128.71±12.24g/l)Science difference(P> 0.05);There was no significant statistical difference in the postoperative hemoglobin between TURBT group(124.23±10.71g/l),BT-ESD A group(124.4±16.48g/l)and BT-ESD B group(125.83±11.33g/l)Science difference(P>0.05);There was significant difference in the postoperative bladder irrigation between TURBT group(1.88±0.74d),BT-ESD A group(1.7±0.65d)and BT-ESD B group(1.44±0.71d)Science difference(P>0.05);There were significant differences in the postoperative catheter placement between TURBT group(3.91±1.53d),BT-ESD A group(3.6±1.5d)and BT-ESD B group(2.42±0.97d)Science difference(P<0.05);There was significant difference in postoperative hospital stay between TURBT group(4.95 ± 1.66d),BT-ESD group A(4.27 ± 0.96d)and BT-ESD B group(3.29 ± 0.87d)Science difference(P<0.05);In terms of postoperative complications,there were 15 cases of postoperative complications in the TURBT group(5 cases of obturator nerve reflex,2 cases of bladder perforation,6 cases of postoperative bladder hemorrhage and 2 cases of vesicoureteral stenosis),BT-ESD A group was 1 case(postoperative bladder hemorrhage),BT-ESD B group was 0 cases.There was significant difference between TURBT group(18.29%),BT-ESD group A(6.67%)and BT-ESD B group(0.00%)Science difference(P<0.05);There was no significant difference in one year after surgery of bladder cancer recurrence rate between the TURBT group(15.85%),BT-ESD group A(7.14%)and BT-ESD group B(4.17%)Science difference(P>0.05).Conclusion:1.BT-ESD is a new surgical method for the treatment of non-muscle invasive bladder tumors,it has better therapeutic effect;2.BT-ESD one-time complete removal of diseased tissue,and not only reduces the spread of residual tumor,more conducive to tumor pathological judgment and clinical staging.In line with the principles of surgical treatment of tumors;3.Compared with TURBT procedure BT-ESD has the advantage of shortening postoperative hospital stay,reducing the incidence of surgical complications and reducing the recurrence rate of bladder cancer.4.After the learning curve,the advantages of BT-ESD are more obvious.BT-ESD is effective,safe and feasible after the complete preoperative assessment and case selection.