目的:观察在经尿道膀胱肿瘤电切术中采用闭孔神经阻滞减少闭孔反射的情况及远期疗效。方法:选取2005年1月～2006年5月期间我科收治的60例确诊膀胱肿瘤患者,严格按照手术适应症随机分为两组:对照组30例单纯硬膜外麻下行经尿道肿瘤电切术,治疗组30例在硬膜外麻醉基础上进行闭孔神经阻滞,观察两组闭孔反射发生率并进行术后随访,观察肿瘤的复发情况。结果:对照组闭孔反射发生率明显高于治疗组(Plt;0.05),经过随访治疗组30例患者3例出现了膀胱肿瘤复发,复发率为10.0%,对照组复发率为13.3%(4/30),两组复发率无明显差异(Pgt;0.05)。结论:在经尿道膀胱肿瘤电切术中采取闭孔神经阻滞能明显减少闭孔反射的发生,明显提高手术的效果,但是改善膀胱肿瘤近期和远期疗效还有待进一步探讨。
Objective To assess the efficacy and the treatment-induced side effects of intravesically administered Epirubicin (EPI) following TUR in patients with Ta and T1 superficial bladder cancer compared to TUR alone. Methods According to the Cochrane reviewer’s handbook, included studies were those on patients with histologically confirmed Ta and T1 bladder cancer. EPI and EPI derivatives, dose and schedule would be considerd appropriate for inclusion. The search strategy was developed according to the Collaborative Review Group search strategy. Medline, EMbase, CBMdisc and the Cochrane library, articles of conference proceedings, and academic collections were searched for randomised controlled trials (RCTs) and quasi-RCT comparing intravesical EPI following TUR with TUR alone. Data were extracted from each identified paper independently by two reviewers. Trials were assessed for quality according to the method of Jadad scale. RevMan4.2 software developed by the Cochrane Collaboration was used for satistical analysis. Results Two hundred and thirteen related articles were identified, but only 10 were included in our systematic review. 3 articles were high quality and the rest were low. The pooled RR=1.51 (95%CI 1.32 to 1.72) and the pooled RR=1.49 (95%CI 1.35 to 1.66) in patients with Ta and T1 bladdercancer at 1 and 2 years respectively; The pooled RR=1.34 (95%CI 1.22 to 1.48) when comparing relative efficacy of intravesical EPI (drug doselt;50 mg) following TUR with TUR alone; The pooled RR=1.63 (95%CI 1.48 to 1.79) when comparing relative efficacy of intravesical EPI (drug dosegt;50 mg) following TUR with TUR alone. RR=1.49 (95%CI 1.33 to 1.66) and RR=1.56 (95%CI 1.36 to 1.84) when comparing relative efficacy of single intravesical EPI following TUR with TUR alone respectively. RR=0.79 (95%CI 0.53 to 1.17) when comparing the incidence of disease progression of intravesical doxorubicin following TUR with TUR alone. RR=4.34 (95%CI 2.62 to 7.19) when comparing side effect of intravesical EPI following TUR with TUR alone. Conclusions Intravesically administered EPI following TUR in patients with Ta and T1 superficial bladder cancer may reduce the incidence of tumour recurrence, but cannot reduce the incidence of disease progreesion. Intravesically administered EPI following TUR has some side effects but can be tolerated and has no influence on the life of patients.
Objective To assess the safety and efficacy of holmium laser resection for superficial bladder cancer (HoLRBT) compared with electrocautery transurethral resection of bladder tumor (TURBT). Methods Such databases as MEDLINE, EMbase, CBM, and The Cochrane Library were searched by computer to include the randomized controlled trials (RCTs) about holmium laser and transurethral electroresection for treating superficial bladder cancer. Meta-analyses were performed by RevMan 5.0 software after the data were abstracted and the quality was evaluated. Results Nine RCTs involving 1 323 patients were included. The results of meta-analyses showed in comparison with the TURBT, there were significant differences in HoLRBT for less intraoprative bleeding volume (WMD= –6.04, 95%CI –6.90 to –5.19), shorter mean bladder irrigating time (WMD= –14.99, 95%CI –17.58 to –12.40), shorter time of indwelling urethral catheter (WMD= –2.46, 95%CI –3.59 to –1.34), fewer postoperative complications such as the obturator nerve reflex (OR=0.03, 95%CI 0.01 to 0.09), fewer events of bladder perforation (OR=0.12, 95%CI 0.05 to 0.31) and lower postoperative recurrence rate (OR=0.70, 95%CI 0.52 to 0.96). Conclusions The current evidence shows that HoLRBT is a feasible, safe, and effective alternative for the management of superficial bladder cancer because of few damages to bladder tissues and less operation bleeding.
ObjectiveTo systematically review the safety and efficacy of greenlight laser photoselective vaporization (PV) for nonmuscle-invasive bladder tumors (NMIBTs). MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 2, 2016), CNKI, CBM, VIP and WanFang Data were systemically searched from inception to February 2016, to collect randomized controlled trials (RCTs) investigating the efficacy and safety of greenlight PV for NMIBTs. Two reviewers independently screened literature, extracted data, assessed the risk of bias of included studies. Then RevMan 5.3 software was used for meta-analysis. ResultsA total of 11 RCTs involving 921 patients met the predefined criteria. The results of meta-analysis showed that: Compared with electrocautery transurethral resection and plasmakinetic resection in treating NMIBTs, greenlight PV could significantly shorten indwelling catheter time and hospital stay, decrease bladder perforation, obturator nerve reflex, blood loss rate and tumor recurrence rate; but the operative time between the greenlight PV group and the routine surgery group was not statistically different. ConclusionCurrent evidence shows that greenlight PV is safe and effective in treating NMIBTs. Due to the limited quality and quantity of the included studies, more large-scale high-quality studies are warranted to further assess these results.
ObjectiveTo evaluate the clinical efficacy and safety of the inguinal approach versus classical pubic approach for obturator nerve block (ONB) in transurethral resection of bladder tumors (TUR-BT).MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to identify randomized controlled trials using ONB in TUR-BT from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using Stata 14.2 software.ResultsA total of 7 studies involving 474 patients were included. The meta-analysis results showed that there was no significant difference between inguinal approach and pubic approach in terms of the ONB success rate (RR=1.06, 95%CI 0.96 to 1.17, P=0.23), while the one-time success rate of puncture of inguinal approach was higher than that of pubic approach (RR=1.47, 95%CI 1.01 to 2.15, P=0.04). Compared with the pubic approach, the overall complications of inguinal approach were lower (RR=0.24, 95%CI 0.08 to 0.71, P=0.01). However, no significant difference was found between the two groups in terms of subcutaneous hematoma (RR=0.46, 95%CI 0.08 to 2.66, P=0.38).ConclusionsThe current evidence indicates that the success rate of one puncture of inguinal approach is higher than that of pubic approach, and the overall complications of the inguinal approach are much lower than that of the pubic approach. However, the above conclusions are still required to be verified through more high-quality studies due to the limited quantity and quality of included studies.
Objective To sum up the common mode in urinary diversion after radical cystectomy. Methods The recent original articles about the common mode in urinary diversion after radical cystectomy were extensively reviewed. Results Urinary diversion includes no continent ureterocutaneostomy, continent ureterocutaneostomy and orthotopic neobladder. Ileal conduit, an ideal procedure of urinary diversion, has been widely used in patients after radical cystectomy and it is uncertain whether the health related quality of life in patients undergoing orthotopic ileal neobladder is superior to those undergoing ileal conduit. A series of basic researches of tissue engineering show a wide prospect of clinical application in the future. Conclusion Intestinal segment will remain the main material for urinary diversion and bladder reconstruction in a long time. Tissue engineering materials may be ideal for the substitution of bladder, and tissue engineering becomes the ultimate approach to solve the problem of missing bladder.