Clinical Research Of Endoscopic Submucosal Dissection(ESD) Assisted High-power Green-light Laser Enucleation And Transurethral Resection In The Treatment Of Non-muscle-invasive Bladder Cancer

Objective:To evaluate the safety and efficacy of endoscopic submucosal dissection?ESD?assisted high-power green-light laser enucleation?ESD-HPL?compared with transurethral electroresection of the bladder tumor?TURBT?in the treatment of primary non-muscle-imvasive bladder tumors?NMIBT?.Clinical Data and Methods:From June 2014 to June 2015,the clinical data of patients with non-muscle-invasive bladder tumors?n=85?treated in Shandong Provincial Hospital were collected and divided into ESD-HPL group?n=45?and TURBT group?n=40?according to different surgical methods.The general physical condition of patients,characteristics of tumors,operation time,hemoglobin decrease,incidence of obturator nerve reflex and bladder perforation of the two groups were recorded and analyzed.The time of indwelling urethra after operation,the average length of hospital stay after operation,the incidence of urethral stricture,and the 36 months follow-up were compared and analyzed between the two groups.Results:The clinical data of 85 patients were enrolled in this study,including 45 cases in ESD-HPL group and 40 cases in TURBT group.There was no significant difference between the two groups in age,sex,tumor characteristics and other preoperative conditions.All operations were successfully completed,and no patient needed blood transfusion.The mean operation time was 20.11 ± 12.73 minutes for ESD-HPL group and 27.13 ± 15.47 minutes for TURBT group?P=0.010?.Hemoglobin decrease at 24h after operation was less in ESD-HPL group,compared with TURBT group?0.81 ±0.33g/dL vs.1.11 ±0.39g/dL,P<0₀01?.No obturator nerve reflex?ONR?occurred during ESD-HPL,whereas four occurred during TURBT,all of which occurred during the treatment of lateral wall tumors,with one case resulting in bladder perforation.The incidence of obturator nerve reflex in the two groups was statistically significant?P=0.045?.Two patients in TURBT group experienced urethral stricture,while none in ESD-HPL group?P=0.218?.The postoperative catheterization time of the ESD-HPL group was shorter than that of the TURBT group?1.97± 1.34d vs.3.05±1.24d,P<0.001?.The mean postoperative hospitalization time was 4.22 ± 2.27d in ESD-HPL group and 4.95 ±2.47d in TURBT group respectively?P=0.124?.Bladder tumors were en-bloc resected in ESD-HPL group,while were traditionally piece-by-piece resected in TURBT group.There were 1 recurrence in ESD-HPL group and 3 recurrences in TURBT group after 36-month follow-up,with no recurrence in situ in both groups.The Kaplan-Meier survival curve showed no significant difference between the two groups?P=0.258?.Conclusion:Endoscopic submucosal dissection?ESD?assisted high-power green-light laser enucleation of bladder tumors?ESD-HPL?is as effective as TURBT in the treatment of non-muscle-invasive bladder tumors.ESD-HPL shows many advantages compared with traditional TURBT,including shorter operation time,less intraoperative bleeding,fewer intraoperative complications and faster recovery.In addition,en-bloc resection of bladder tumors contributes to accurate pathological grading,which is of great value in predicting postoperative prognosis and the selection of follow-up treatment.Therefore,ESD-HPL can be used as an alternative operation for the treatment of non-muscle-invasive bladder tumors,which is worth promoting and improving.