探討維拉雷射應用於內視鏡膀胱腫瘤刮除術之安全及可行性

張哲維^1,3,4, 耿俊閎^1,2,3,4, 詹鎮豪^1,2,3,4, 王巽玄^1,3,4, 沈榮宗¹,李永進^1,2,3,4

高雄市市立小港醫院 泌尿部¹；高雄醫學大學臨床醫學研究所²；高雄醫學大學附設醫院 泌尿部³；高雄醫學大學⁴

The Safety and Efficacy of Endoscopic Resection of Bladder Tumor with Vela Laser– A Single Center Experience

Che-Wei Chang^1,3,4, Jiun-Hung Geng^1,2,3,4, Jhan-Jhen Hao^1,2,3,4, Hsun-Shuan Wang^1,3,4, Rong-Zong Shen¹ and Yung-Chin Lee^1,2,3,4

¹Department of Urology, Kaohsiung Municipal SiaoGang Hospital, Kaohsiung, Taiwan; ²Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; ³ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; ⁴Kaohsiung Medical University, Kaohsiung, Taiwan

Objectives

    The current gold standard treatment of bladder cancer is transurethral resection of bladder tumor with Monopolar or Bipolar resectoscope (CTURBT). Laser en-bloc resection of bladder tumor (LERBT) could achieves higher quality of the specimen, reduces peri-operative complications, and may decreases the recurrence rate. Higher quality of the specimen could help differentiate between non-muscle and muscle invasive disease. Here, we compare the efficacy and safety of en-bloc Vela laser resection versus the conventional Monopolar/Bipolar resection.

Material and Methods

    A total 64 clinically cTa-cT2 patients were retrospectively reviewed in this study. Among these patients, 34 patient received LERBT and 30 patients received CTURBT. The baseline characteristics, operation variables and clinical outcome were collected. The primary performance is the inclusion of muscle component in the specimen. Peri-operative complications and recurrence-free survival (RFS) were also compared. Independent t test, Chi-square test and Kaplan-Meier curves were used in the analysis.

Results

    The median age of patients in laser and resectoscope group are 66.8 and 67.2 years old, respectively. There is statistical difference in muscle inclusion rates that are 88.2% in laser group and 66.6% in resectoscope group (p=0.03). Also, we found shorter catheterization time (p=0.019), hospitalization time (p=0.007) and complicate rates (p=0.05) in LERBT group. However, no statistical difference was noted in RFS after median follow up time of 13 months.

Conclusions

    Endoscopic laser en-bloc resection of bladder tumor with Vela laser is an effective method with higher muscle inclusion rate and fewer complications. The clinical outcomes of LERBT is non-inferior compared to CTURBT.