Transurethral resection of bladder tumor

Treatment of diseases: bladder tumors Indication Transurethral resection of the bladder tumor is applicable to: The in situ carcinoma of bladder tumors has a diameter of less than 5 mm, and the diameter of exogenous carcinoma and inverted papillary carcinoma is less than 5 cm, and the invasive carcinoma is B1T2, which is low. In order to determine whether it can be cut, under the anesthesia, men should undergo transrectal and female transvaginal double examination to check the tumor fixation and hardness, which is helpful to judge the size and stage. It can be used as a transurethral intraluminal B-ultrasound and MRI, and it can judge the size of the tumor and the depth of invasion. Take the tissue biopsy to determine the level. These are important for deciding whether or not to perform an endoscopic resection. Advanced cancer resection can relieve symptoms. Contraindications 1. Severe cardiovascular disease. 2. The coagulation function is obviously abnormal. 3. Non-migrating epithelial tumors, such as adenocarcinoma, squamous cell carcinoma. 4. Acute cystitis. 5. Spinal deformity can not be supine. 6. Untreated urethral stricture. Preoperative preparation Most patients with benign prostatic hyperplasia are elderly, usually with coronary artery, valve and hypertensive heart disease, as well as cerebrovascular disease, chronic lung disease, renal insufficiency, and diabetes. Be sure to carefully understand and properly treat these diseases before surgery. There should be no obvious blood disease, and the coagulation function is basically normal. Surgical procedure 1. Carcinoma in situ In situ cancer is difficult to see because of the special performance of the mucosa. Sometimes it can be expressed as a regional acute or chronic cystitis. It is difficult to make a diagnosis by simple cystoscopy. In most cases, detailed examination is required to examine the appearance of the bladder mucosal surface with different angles of endoscopy and different brightness at different filling levels of the bladder. Biopsy is best to use ring biopsy forceps, take more tissue, from the bladder neck, two side walls, the back side wall, both sides of the ureteral orifice, triangle, basal and male prostatic urethra, or female urethra, each take tissue 1 piece, do regular section or cryosection. The diameter of the in situ carcinoma resection is not more than 5 cm in diameter, and it is best to use the ball head to coagulate and destroy. It is actually difficult to determine the extent of cancer in situ, so urine cytology (1 time per week) and cystoscopy (1 time in the first 3 months) must be performed regularly after treatment. 2. Excision of exophytic carcinomas Exogenous cancer is a cancer that protrudes from the mucosal surface, grows outward, and infiltrates. Single or multiple, the volume can be large or small, can occur in any part of the bladder. Low-grade cancers often appear as fine villi and have a thin band. High-grade cancer is firmer and has a thick fiber-like pedicle. When the bladder tumor is removed by resection, the bladder perfusate is 150 to 200 ml each time. In order to make the capacity relatively fixed in the medium capacity range, the bladder wall is thick and difficult to perforate. Usually a small electric cut ring is used, the current is 50-70 mA, and the electrocoagulation current is 40-50 mA. Rinse the water to use a hypotonic liquid. In theory, it can destroy cancer cells. For extroverted lesions, the electric cut starts from the most easily resected site. Except for the posterior wall of the bladder or the tumor with a triangle of <1 cm, it is rare to start the tumor pedicle and remove the tumor. Hemostasis is more difficult when the "frondular portions" of the tumor are removed; but once the pedicle is cut, the procedure is easy to complete. The arterial hemorrhage usually encountered is easily blocked by electrocoagulation when the tumor pedicle is cut and normal muscle is reached. The specimen should be removed and the pathological examination should be sent. If there are multiple tumors, the highest person should be removed first, especially at the top. Otherwise, the lower lesion is cut first, and the bubble formed during the excision rises, which can blur the top lesion. Air bubbles generated during the removal of the top tumor can be removed by a ureteral catheter. The tumor at the top may be difficult to reach the electric cut. In this case, the bladder filling should not be too large, and the assistant presses the pubis with the hand to make the tumor enter the surgical field. The electric cut of the side wall tumor is similar to that of the prostate. It can be pushed forward or cut, and the electric cut activity should be consistent with the front of the bladder. When the tumor of the lateral wall is resected, it is easy to induce obturator nerve reflex and cause thigh bounce. At this time, the electric resection should be stopped, and 2 to 10 ml of 0.25% lidocaine sodium (or cumin) is injected under the submucosal tumor. After 1 min, the electric resection was performed. The posterior wall tumor should be fixed to the position of the electric cutting ring, together with the mirror sheath, or cut from the bottom to the top, or from one side to the other side. It is also useful to cover the tumor pedicle with a snare, and to remove the shrinking snares one by one. 3. Infusion of infiltrate carcinomas Indications for transurethral resection of invasive carcinoma are only suitable for bladder cancer that infiltrates into the muscular layer and B1T2 phase. The vast majority of tumors can be resected to normal mucosal levels. The electric cut starts from the edge of the tumor, and then moves toward the center, from the surface to the deep layer, and must stop the bleeding completely before ending one area and preparing to move to another area. The excision must be deep into the muscular layer and the depth must be confirmed by pathology. The resection range must be more than 0.5 cm above the edge of the tumor. Electrocoagulation with electric balls requires random biopsy according to the above methods and areas. When the lower wall tumor is resected, it is easy to induce obturator nerve reflex, which may lead to perforation or incomplete resection of the bladder wall. Avoiding excessive expansion of the bladder, changing the position of the electric cutting ring, or reducing the current can not effectively prevent sputum. Oral amber oxime or tubocurarine chloride can be administered, but an intratracheal intubation is required for general anesthesia. You can inject a tumor solution containing 0.25% lidocaine into the submucosal muscle layer of the tumor by operating a cystoscope, and inject 5 to 10 ml according to the size of the tumor base, and then remove it after 1 minute to prevent stimulation. The pore nerve causes the thigh to violently beat, which is itself a treatment for the tumor. If the bladder tumor is removed by laser, it does not cause obturator nerve reflex, and the bleeding is less, but the speed is slow, especially suitable for tumors with side walls <2cm. complication Bladder perforation is the most important complication of transurethral resection of bladder tumors. The preventive measure is to avoid overfilling of the bladder during resection. Extraperitoneal perforation only requires indwelling catheter drainage and antibiotics. If the peritoneal cavity is perforated, the bladder should be surgically sutured.