臺灣博碩士論文加值系統

表淺性膀胱癌的標準治療方法是使用內視鏡經由尿道進入膀胱，以環狀電刀將腫瘤分割切除，但是手術的併發症與手術後的腫瘤復發是常見的問題。理論上如果能夠將腫瘤完整地切除而不破壞其結構，應該可以降低復發率。本研究探討以銩雷射輔助來完成膀胱腫瘤的整塊切除，針對手術的併發症與手術後的復發率與傳統的手術作比較。從2010年1月到2012年12月，我們回溯分析20位膀胱癌的病人，收案的條件為新診斷而尚未接受治療的膀胱癌，並且以電腦斷層掃描確定腫瘤局限於膀胱內。若有膀胱外侵犯、轉移、或原位癌的病人則排除在本研究之外。這20位病人分別有十位接受經尿道銩雷射膀胱腫瘤切除術，另外十位接受傳統經尿道膀胱腫瘤切除術。手術結果的比較上，這兩組病人在術中皆未發生立即的併發症，而傳統經尿道膀胱腫瘤切除術有一位病人於術後第十天發生膀胱出血，因此又再次手術進行止血。兩組病人術後追蹤皆未出現腫瘤復發現象。銩雷射手術短期內在癌症控制上與傳統手術相同，但它發生手術併發症機率較低，改善了手術品質與病理分期的精確度。

The standard of care for the superficial bladder cancer is transurethral resection of bladder tumor (TURBT), using cautery cutting loop to peel off the tumor piecemeal. There are some complications with this technique and the process of peeling might lead to exfoliated cancer cells which are suspicious of causing recurrences. Theoretically, if the tumor can be removed with en bloc resection, the recurrent rate of the tumor can be minimized. In this study, we used thulium (Tm:YAG) laser to assist en bloc resection of the superficial bladder cancer. Complications and recurrence rate in Tm:YAG laser was compared to the conventional TURBT. We retrospectively analyzed 20 patients with newly diagnosed superficial bladder cancer from January 2010 to December 2012. All the patients included must be treatment-naive. No extravesical tumor extension was confirmed by computed tomography scan. We excluded carcinoma in situ and metastatic bladder cancer. Ten of the patients underwent Tm:YAG laser surgery and the others conventional TURBT. There was no intraoperative complication after both Tm:YAG group and TURBT group. However, in TURBT group, there was bladder bleeding in one patient ten days after the operation, resulting in clot retention, which was treated with surgery. There was no tumor recurrence in both groups during short term follow-up. The oncological control of bladder cancer in Tm:YAG surgery is comparable to the conventional TURBT, at least in the short term. However Tm:YAG surgery has lower post-operative complications than TURBT, and it can provide better intra-operative specimen for more precise pathologic analysis. Thus Tm:YAG improves the quality of the operation in superficial bladder cancer.

摘要................................................................ I
誌 謝............................................................... III
目 錄............................................................... IV
圖目錄............................................................... VI
表目錄............................................................... VII
第一章 緒論 .......................................................... 1
1-1 前言............................................................. 1
1-2 膀胱癌的危險因子及病因............................................... 3
1-3 臨床分期.......................................................... 4
1-4 症狀及診斷........................................................ 6
1-5 膀胱癌的治療....................................................... 8
1-6 研究目的.......................................................... 11
第二章 文獻回顧........................................................ 12
2-1 表淺性膀胱癌的傳統手術方式........................................... 12
2-2雷射在泌尿內視鏡手術的應用............................................ 13
2-3 以銩雷射切除膀胱腫瘤手術的文獻........................................ 18
第三章 樣本資料與治療方法................................................ 20
3-1 病患樣本選擇....................................................... 20
3-2 儀器與設備......................................................... 22
3-2-1 雷射設備......................................................... 22
3-2-2 雷射設備使用方法.................................................. 23
3-3 治療方法........................................................... 23
3-4 術後的治療及定期檢查方式.............................................. 24
第四章 結果與討論....................................................... 25
4-1 術前資料分析....................................................... 25
4-2 術後結果比較....................................................... 27
4-3 討論.............................................................. 28
第五章 結論............................................................ 33
第六章 未來展望......................................................... 34
參考文獻............................................................... 35

圖目錄
圖1-1 2010年台灣膀胱惡性腫瘤發生率與死亡率之年齡分布...........................2
圖1-2 膀胱鏡中所見的膀胱腫瘤...............................................5
圖1-3 膀胱癌臨床分期......................................................6
圖1-4 經尿道膀胱腫瘤切除術、膀胱局部切除術....................................9
圖1-5 經尿道膀胱腫瘤切除術................................................10
圖1-6 經尿道膀胱腫瘤切除術可能導致膀胱破裂...................................10
圖2-1 使用經尿道膀胱內視鏡切除腫瘤..........................................13
圖2-2 各種雷射的波長，水中的能量吸收係數.....................................16
圖3-1 病患樣本選擇.......................................................20
圖3-2 膀胱腫瘤整塊完整性切除...............................................24
圖4-1 膀胱鏡檢查中所見的表淺性乳突狀瘤.......................................26
圖4-2 電腻斷層中所呈現的膀胱腫瘤............................................26

表目錄
表1-1 2010年台灣初診斷為膀胱惡性腫瘤之個案數...................................2
表2-1 各種醫療用雷射對組織的特性.............................................17
表3-1 Tm:YAG group的病人及腫瘤特性.........................................21
表3-2 Conventional group的病人及腫瘤特性...................................21
表3-3 雷射源儀器規格.......................................................22
表3-4 內視鏡手術器械.......................................................22
表4-1 Tm:YAG group的術後情況..............................................27
表4-2 Conventional group的術後情況........................................28
表4-3 Tm:YAG group及Conventional T group結果的比較.........................29

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