摘要目的 评价窄谱光成像(NBI)辅助钬激光治疗非肌层浸润性膀胱尿路上皮癌(NMIBC)的可行性及其对术后肿瘤残留率的影响.方法 2013年5月至2014年12月山东大学第二医院泌尿外科初步诊断为原发性膀胱肿瘤的150例患者按照简单随机化对照研究方法,分为NBI辅助钬激光膀胱肿瘤切除组(NBI-HoLRBt组)和传统的经尿道膀胱肿瘤切除组[普通白光成像(WLI)-TURBt组].NBI-HoLRBt组分别行WLI膀胱镜和NBI膀胱镜检查,然后在WLI下完成所有肿瘤及可疑病变的钬激光切除,NBI下钬激光切除仅限于在NBI下发现的病变;切除完成后,再用NBI膀胱镜检查所有切除区域,最终确定是否有肿瘤残留.WLI-TURBt组只用WLI膀胱镜检查,然后在WLI下完成TURBt.术后均行常规灌注治疗.两组病理证实为NMIBC的124例患者纳入随访,其中NBI-HoLRBt组60例,WLI-TURBt组64例.比较NBI与WLI膀胱镜在肿瘤检出率,尤其是原位癌上的差异.将3个月首次随访或部分高危患者二次切除的复查情况作为首次随访结果,比较两组首次随访的肿瘤残留率,评价NBI-HoLRBt治疗NMIBC的可行性.结果 NBI膀胱镜在肿瘤检出率和原位癌检出率方面,明显高于WLI膀胱镜[94.5％(137/145)比75.8％(110/145),16/17比10/17,均P＜0.05].首次随访肿瘤残留率在NBI-HoLRBt组为3.3％(2/60),而WLI-TURBt为17.2％(11/64)(P＜0.05).结论 NBI-HoLRBt治疗NMIBC操作简单,疗效确切,能显著降低NMIBC的肿瘤残留率,是治疗NMIBC的一种理想的手术方式.

abstractsObjective To assess the feasibity and efficacy of narrow band imaging (NBI) cystoscopy assisted holmium laser resection of primary non-muscle invasive bladder cancer (HoLRBt).Methods During the period of May 2013 to December 2014,150 cases of primary non-muscle invasive bladder cancer (NMIBC) admitted in our hospital were randomly divided into NBI-HoLRBt and WLI-TURBt group.In NBI-HoLRBt group,all suspicious lesion identified by either WLI or NBI were resected during the surgery with WLI and in NBI mode for lesion only visible with NBI.At the end of the procedure,NBI cystoscopic examination was performed again to identify whether there was residual lesions at the margins of the resection areas.In WLI-TURBt group,only WLI and TURBt were applied.All patients from the two groups underwent routine intravesical instillation after surgery.A total of 124 patients were diagnosed NMIBC by pathological findings(NBI-HoLRBt group:n =60,WLI-TURBt group:n =64),they were followed-up at 3 months,at which both WLI and NBI cystoscopy were performed to examine the residual tumor,and cytology was checked for all patients.The residual tumor rates at the first follow-up (RR-fFU) were recorded and compared.Results Baseline characteristics of the patient and the tumor were comparable between the two groups.The overall detection rate of NMIBC and carcinoma in situ (CIS) were significantly higher with NBI than WLI (94.5％ (137/145) vs 75.8％ (110/145),16/17 vs 10/17,both P ＜ 0.05).The RR-fFU for NBI-HoLRBt and WLI-TURBt was 3.3％ (2/60) and 17.2％ (11/64),respectively (P ＜ 0.05).Conclusion NBI-HoLRBt was feasible,and more effective for identification of NMIBC as well as for the reduction of residual tumor rate compared with WLI-TURBt.