经尿道膀胱肿瘤黏膜下剥离术联合术中膀胱黏膜下注射吉西他滨治疗膀胱非肌层浸润性尿路上皮癌的疗效观察（附7例报告）

Efficacy of transurethral submucosal dissection of bladder tumor combined with intraoperative bladder submucosal injection of gemcitabine in treatment of non-muscle invasive urothelial bladder cancer: a report of seven cases

摘要:

目的 探讨经尿道膀胱肿瘤黏膜下剥离术联合术中膀胱黏膜下注射吉西他滨治疗膀胱非肌层浸润性尿路上皮癌（non-muscle invasive urothelial bladder cancer，NMIBC）的安全性及有效性。方法 回顾性分析2021年6月至2022年9月攀钢集团总医院泌尿外科收治的7例单发NMIBC患者临床资料。利用专用膀胱黏膜注射针经膀胱镜于肿瘤基底部注射吉西他滨（20 mg/mL）形成局部水肿后行膀胱肿瘤内镜黏膜下剥离术（bladder tumor endoscopic mucosal dissection，BT-ESD）。记录手术时间、术后住院时间、术后病理结果、术后并发症发生情况，估算术中出血量，术后3个月及术后1年复查膀胱镜，统计复发率。结果 7例患者顺利完成BT-ESD，无中转开放手术及改为其他手术方案。术后无非计划再次手术止血，未发生创面膀胱穿孔，术中无输血。其中男性5例，女性2例，肿瘤最大径0.7～2.0 cm，平均（0.9±0.4） cm，肿瘤均为菜花状，带蒂，位于膀胱侧壁2例，右侧输尿管脊2例，左侧输尿管脊2例，三角区1例。手术时间20～40 min，平均（31.40±2.67） min。术中出血量1～5 mL，平均（2.24±1.46） mL。术后住院时间1～2 d。手术后病理结果为低风险非肌层浸润性膀胱尿路上皮癌，手术切缘均为阴性。术后3个月及术后1年，复查膀胱镜，未见复发、进展。结论 膀胱肿瘤内镜黏膜下剥离术中膀胱黏膜下注射吉西他滨治疗非肌层浸润性尿路上皮膀胱癌是安全、可靠、有效的。

Abstract:

Objective To investigate the safety and efficacy of transurethral submucosal dissection of bladder tumor combined with intraoperative bladder submucosal injection of gemcitabine in the treatment of non-muscle invasive urothelial bladder cancer（NMIBC）.Methods A retrospective analysis was performed for the clinical data of seven patients with solitary NMIBC who were admitted to our department from June 2021 to September 2022. Bladder tumor-endoscopic submucosal dissection（BT-ESD） was performed after the formation of local edema by injection of gemcitabine（20 mg/mL） at the base of the tumor via cystoscopy using a special bladder mucosal injection needle. Time of operation，length of postoperative hospital stay，postoperative pathological findings，and postoperative complications were recorded，and intraoperative blood loss was estimated. Cystoscopy was performed at 3 months and 1 year after surgery，and recurrence rate was calculated.Results All seven patients underwent successful BT-ESD，with no patients converted to open surgery or other surgical regimens. There was no unscheduled postoperative reoperation for hemostasis，traumatic bladder perforation or intraoperative blood transfusion. Of all seven patients，there were five male patients and two female patients，and the maximum tumor diameter ranged from 0.7 to 2.0 cm，with a mean diameter of （0.9±0.4） cm；all tumors were cauliflower-shaped and pedicled and were located in the lateral wall of the bladder in two patients，in the right ureteral ridge in two patients，in the left ureteral ridge in two patients，and in the trigone in one patient. The time of operation was 20-40 minutes，with a mean time of （31.40±2.67） minutes. The volume of intraoperative blood loss was 1-5 mL，with a mean volume of （2.24±1.46） mL. The length of postoperative hospital stay was 1-2 days. Postoperative pathological findings showed low-risk NMIBC with negative surgical margins. Cystoscopy was performed at 3 months and 1 year after surgery and showed no recurrence or progression.Conclusion The submucosal injection of gemcitabine into the bladder during BT-ESD is safe，reliable，and effective in the treatment of NMICB.