N g h i e n a r u Y h o c ^ ^^^'^ ^ ^ - ^° ^^^ ^ ^ " ^ * ^ ^ P 1^ * S o 1 * 2 0 1 4
DANH GIA KET QUA SOM DIEU TRI UNG THU* BANG QUANG KHONG XAM LAN CO BANG CAT DOT QUA NGA NIEU DAO
VOI THULIUM YAG LASER KET HOP MITOMYCIN C TRONG BANG QUANG SAU MO
Nguyen Van An*, Nguyen Ngoc Chau*, Nguyin Hoang Luaig**
T O M T A T
M\ic tieu: Ddnh gid kit qud sdm dieu trj ung thu bdng quang Idiong xdm lah ca (ung thu bdng quang iioiig) bdng cdt doi qua ngd nieu dqo vdi Tliulium YAG laser kei hgp hoa tri trong bdng quang bdng mitomycin Csau mo.
Ddi tugmg vd phuong phdp nghiin dhu Nghidi cieu tiai aru bdo cdo lidng loat tnedng liap baih. Doi tugng gdm 22 badi nhdn bi ung thu bdng quang nong dugc dmi tri tqi benh viai Binh Dan tie tiidng 06/2012 deii thdng 07/2013. Benh nhdn duac plidu thudt cat dot biedu qua ngd nieu dqo vai Thulium YAG laser, sau do dirge bom hoa chdi vdo bang quang voi 40mg mitomyan C moi tiian mot Idn dai dii sdu chu ky. Ddnh gid ixl qud sdm vdi tdildidm vdo tiidng thie 3 vd 6 sau mo'.
Kit qua: Ti li nam tiin nd". 3,4/1. Thai gian nw trung binh' 25,8 ± 8,4 phdt Solan plidn xq tlidn kinh bjt:
0%, thung bdng quang: 0%, didy mdu klidng cam dugc- 0%, bam n'ea bdng quang sau nw: 0%. Thcri gian lieu thong nieu dqo - bdng quang: 1,6 ± 0,4 ngdy. Kei qud s&m ngay sau phdu thuqti hdu hit cho kii qud toi (90,9%).Tciig so'gom 22ca nghiin a'eu, so'benh nhdn tdi phdt theo doi a thdng thie 3 la ll20ca (mdi lien lac 2ca), d thdng thu 6 Id 2/19ca (mdi liin Iqc thim lea).
Kei ludn: Phuang phdp eat dot qua ngd niiu dqo vai Thulium YAG laser diiu tri cho ung thu bdng quang nong cho kei qud s&m Id toi, co do an todn cao, de thuc hien vd hdu nhu Id khong cd tai biin - biai chhig.
Tic kliSa: Ung thie bang quang nong, cdt dot qua nga nieu dqo. Thulium YAG laser.
A B S T R A C T
EVALUATION THE EARLY RESULTS OF THULIUM YAG LASER TRANSURETHRAL RESECTION OF NON - MUSCLE INVASIVE BLADDER CANCER COMBINED WITH INTRAVESICAL
MITOMYCIN C AFTER OPERATION
N g u y e n Van An, N g u y e n Ngoc Chau, N g u y e n H o a n g L u o n g
* Y H o c T P . H o Chi M i n h ^ V o l . 1 8 - N o 1 - 2014: 330 - 335
Objective: To evaluate tlw early residts of Thulium YAG laser ti-ansurethral resection of non - musde invasive bladder cancer combined zoith intravesical chemotherapy ofmitomydn C afier operation.
Materials arui methods: Prospective cases study zoas realized on 22 cases cfnan - muscle invasive bladder cancer to ti-eat at Binh Dan hospital fi-om 06/2012 lo 07/2013. Patiaits were reseded tiansurethrally by Thulium YAG laser, then injeded intravesically six doses c^40mg mitomydn C afier opaation once a zoeek We evaluate the early results andfollozo - up the patiaits in 6ie 3"* and 6"' month
Results:Tlic rate of maldfemale: 3.4/1. The average time of operation: 25.8 ± 8.4 minutes. The rate of (d^tiiralor nerve refiex: 0%, bladder perforation: 0%, perioperative bleeding: 0%, tiansfusion afier operation: 0%.
* Khoa Nieu A - benh vien Binh Dan **Hpc \'ien Cao hoc Nieu thuc t | p tai benh vien Binh Dan Tdc gid lien lac: PGS.TS. N g u y i n Van An DT: 0908 163 284 Email vanan63g'vahoo com
3 3 0 H o i N g h i K h o a H p c K y T h u ^ t B V . B i n h D a n 2 0 1 4
Y Hpe TP. Ho Chi Minh * Tap 18 * So 1 * 2014 Nghien cuoi Y hoc Catlieterization time: 1.6 ± 0.4 days. Tlie early results: good evaluation zoas the highest (90.9%). Reaaraice patiaits follow - up in the 3"' month zoas 1/10 cases and the 6"' month was 2119 cases.
Ccmclusion: Thulium YAG laser tiansurethral resection of non - musde invasii^e bladder canca- is good early results, high safety, easy to implement and dmost no complications.
Key words: Non - musde inzmsive bladder canca; transurethral resection, Tliulium YAG laser D A T V A N D E
Ung thu bang quang la b|nh ly ung thu thuang gap, dung hang thii tu sau ung thu tuyen hen li^t, phoi va dai tnic trang 6 nam, chiem 6,6% trong tong so ung thu nam, con 6 nii thi no dung hang thu chin, ehiem 2,4% trong t6ng so ung thu nii"'"'. Ngay nay, nho sy phat tri&h eua chah doan hinh anh va giai phau benh ma ung thu bang quang nong ngay cang duoc phat hien nhieu hon.
Trong nhieu nam qua, cat dot noi soi bang dao dien don cue dieu tn cho cac ung thu bang quang nong la phuong phap tieu chuan va duge nhieu nha nieu khoa lya chpn. Tuy nhien, trong qua trinh ap dung phuang phap nay, nguoi ta da ghi nhgn dupe cae nguy co bat loi nhu: chay mau trong luc mo va hau phlu, phan x? than kinh bit, thung bang quang, kha nang khong cat het budu...PI.
Voi SU' phat trien ciia khoa hpe eong nghe va doi song con nguoi ngay cang dugc nang len, yeu cau ve mot phuong phap an toan hon la mpt tat yeu. Voi nhimg tneh vpng eua ky thuat laser va nhimg ling dung cua no hong linh vuc nieu khoa, nen co nhieu y tuong da dupe dat ra la diing laser de dieu tri eho eae ung thu bang quang nong. Hien nay, co nhieu cong trinh nghien cuu cho thay hieu qua va dp an toan cao cua viec ung dung laser vao dieu tri eae benh ly nieu khoa noi ehung va ung ttiu bang quang nong noi riengi^i.
Voi mong muon gop phan nghien cuu va ling dung mpt ky thuat moi - ky thuat laser - vao viec dieu tri cac ung thu bang quang nong, chiing toi tien hanh de tai nay nham danh gia ket qua som dieu Iri buou bang quang nong bang cat dot qua nga nieu dao voi Thulium YAG laser ket hpp bom mitomycin C trong bang quang sau
chu ky sau mo.
DOT TU'ONG VA PHU'ONG PHAP Doi tupng nghien cmi
Tat ca cac benh nhan dugc chan doan ung thu bang quang nong va dieu tri tai b^nh vien Bmh Ban hr thang 06/2012 den thang 07/2013 bing phlu thuat cSt dot qua nga meu dao voi Thulium YAG laser ket hgp vod hoa tri trong bang quang bang mitomycin C sau chu ky sau phlu thuat.
Tieu chuan chgn benh
- Tat ca cac t>enh nhan dupe ehah doan ung thu bang quang nong bang giai phau benh ly theo heu chum cua UICC nam 2002 (cSp nhat nam2009)i'i.
- Tat ca cac benh nhan duge chan doan te bao hgc thugc dang ung thu te'bao chuyen tiep.
- Benh nhan dupe giai thich va dong y tham gia nghien ciiu.
Tieu chuan Ioai tru
' Dang ung thu bang quang xam lah co hay khong phai dang ung thu tebao chuyen tiep.
- B#nh nhan khong hep xiic: tam than, cam, diec...
- Co chong chi dinh mo npi soi: hep nieu dao, dang nhiem trung he tiet ni^u, di chiing chah fhuong khung chau hay khop hang khong the nam tu the san khoa, kem b^nh ly ngi khoa chua on dinh...
Fhuong p h a p nghien cmi Thiei ki'nghien cuu
Nghien eiiu hen cuu bao cao hang loat trudng hpp benh.
Nghien cihi dqc diein benh hgc
Kham va ghi nhan cac dac diem ehung (gioi
Nghien cmi Y hpc Y Hpc TP. Ho Chi Minh * Tap 18 * So 1 * 2014 hnh, tuoi...). Cac dae diem ve lam sang (thoi
gian benh, tieu mau...) va can lam sang (sieu am, soi bang quang, c r - scan...)
Ddnh gid kei qua dteu tri
Cat dot buou bang quang nSng qua nga nieu dao vol Thulium YAG laser, ghi nhan cac dae diem ve dsii the ciia buou (vi tri, so lupng, kich thuoc, xam lah mieng nieu quan hay khong...), danh gia thoi gjan phau thuat danh gja tai bien - bien chiing (phan xa than kinh bit, thung bang quang chay mau khong cam duac...), thoi gian luu fhong nieu dao - bang quang, thai gian nim vien. Mau b?nh phaim thu duge segiii lam xet nghiem gjai phau benh chia lam 3 lo rieng biet (than Clia buou, chan ciia buou va mep c3t xung quanh chan buou).
Phuong phap hoa tri trong bang quang voi mitomycin C sau mo: lieu dau tien duoc tieh hanh trong vong 6 gio dau sau mo, vi day la thoi diem tot nhafif'.Benh nhan duoc bomthuoc dinh ky moi tuan 1 Ian trong 6 tiian lien tiep. Lieu hoa trj nhu sau: 40mg Mitomycin C pha vol 50ml Natrielorua 0,9% duoc bom vao bang quang qua thong nieu dao - bang quang va huong din b?nh nhan luu thuoc trong bang quang toi thieu 2 gio.
Danh gia ket qua som sau phau thuat®>:
- Ket qua tot nhu phau thuat an toan, cit dot het buou nliin thay dupe, khong co bien ehiing, khong CO nhiem trimg sau mo.
- Ket qua kha nhu cat dot het buou nhin thay dupe, CO bien ehiing nhe dieu tri dugc, benh nhan xuat vien an toan, co nhiem trimg sau mo nhung dugc dieu tri khoi.
- Ket qua xau nhu khong cat het to chiic budu, phai chuyeh tii mo ngi soi sang mo duong tren xuong mu, co bien ehung Ion trong phau thuat nhu chay mau, hpi chiing ngi soi, thiing bang quang... can can thiep phau thuat hay tii vong.
Tai kham b?nh nhan: benh nhan dugc hen tai kham dinh ky vao thang thii 3 va thang thii 6 sau mo. Cac tieu chi theo doi liic tai kham gom
trieu ehung lam sang, xet nghiem nuac tieu, sieu am, soi bang quang. Qua do ghi nhan su tai phat Clia buou bang quang nong.
K E T Q U A
Chiing toi tien hanh nghien euu tren 24 benh nhan, tuy nhien co 2 benh nhan bi loai (vi eo 01 truong hgp la viem bang quang dang u va 01 truang hpp xam lah co). Con Ifii 22 t>enh nhan dugc chpn vao mau nghien eiiu ciia ehiing toi voi cac dac diem ghi nhan duoc nhu sau:
Bang 1: Giai cita binh nhdn Groi
Nam NO Tong
SoBN 17 5 22
Tyi#(%) 77,3 22,7 100 Ty le n a m gioi la chii yeu 17/22 (77,3%) t r u o n g h p p . Voi n a m / n i i la 3,4/1.
Bdng 2: Tuoi a'la benh nhdn Tuoi
£20 2 1 - 4 0 4 1 - 6 0 6 1 - 8 0
>80 Ting
S6BN 0 1 8 9 4 22
Tyle{%) 0 4,5 36,4 40,9 18,2 100 Dp tuoi t r u n g binh la 63,4 ± 12,4. D p tu6i m a c b e n h t h u o n g g a p la 61 - 80 tiioi (40,9%).
Bdng 3: Ly do vdo vien Lydo Tiku mau
Khac Tong
SdBN 19 3 22
Tyle(%) 86.4 13,6 1O0 Benh n h a n d e n k h a m vi tieu m a u la chii yeii voi ty le 86,4%.
Bang 4: Tlidi gian nghi nga mac benh Thoq gian (thang)
<6 6 - 1 2
>12 T6ng
S6BN 16 5 1 22
Ty le (%) 72,7 22,7 4,6 100 Sv xac dinh tuong doi hi khi co tieu mau hay phat hien dugc khoi u bang quang cho den khi nhap vien, da so benh nhan den dieu tri truoc 6 tiiang (16/22 b^rong hop).
332 Hpi Nghi Khoa Hpc Ky Thuat BV. Binh Dan 2014
Y Hpc TP. Hb Chi M i n h * T^p 18 * Sb 1 * 2014 Nghien cuu Y hpc Cac dae diem cua buou bang quang quan sat
dugc khi tien hanh cat dot noi soi:
Bdng 5: Kich thudc ciia birdu Kich thiKK
<3cm a 3cm Tong
S6BN 18
4 22
Tyl#(%) 81,8 18,2 100 Bang 6: So'lugng cua birdu
S6lux>Tig 1 b u ^ 2 - 7 buou
>8bira'u T<Sng
SoBN 14 8 0 22
Tyl?(%>
63,6 36,4 0 100 Bang 7: Vi tii cda bu&u
Wtri Hai thanh ben TTianh truo'c va chop
Khac T6ng/22ca
Sou 21
3 7 31
Tyle(%) 67,7
9,7 22,6 100 Kich thuoc buou thuang g§p la duoi 3cm (81,8%), so luong buou thuong gap la 1 buou (63,6%), vi tri thuong gap la hai thanh ben (67,7%) va day ciing la vi tri thuong xuyen xay ra phan X? than kinh bit neii dung dao eat bang dien don cue.
Bdng 8: Dqc diem tiong vd sau phdu thuat vdi Thulium YAG laser
Dac didm Th&i gian mo (phut) Phan xa thin kinh bit Thung bang quang Chay mau khong ciim duoc
Bom rua BQ sau m6 S6 ngay \\iu thong NO - BQ
S6 ngay nim vi#n
Thong sd 25,8 ±8,4 0/22 ca 0/22 ca 0/22 ca 0/22 ca 1,6 ±0,4 2,9 ±0.7 Bang 9: Do biit Iwa ciia bu&u
Qif bi^t hoa Grade 1 Grade 2 Grade 3
SoBN 7 12 3
Tyl&(%) 31,8 54,5 13,7 Bang 10: Kei (jna sirm sau monoi so
Ket qua rot Kha Xau
SoBN 20 2 0
Tyle (-A) 90,9
9,1 0 Co 2 truong hpp cho ket qua kha la do buou
nam viing tam giac, benh nhan bi kich tiiich sau phau thuat.
Theo doi khi sau hoa tri trong bang quang voi mitomycin C, co 5/22 truang hgp bi tieu buot, cam giac rat trong bang quang... thuang ti^
khoi sau 1-2 tuan.
Chiing toi theo doi benh nhan sau mb vao thai diem thang thii 3 va thii 6 bSng xet nghi|m nude tieu, sieu am va soi bang quang.
Co 19/22 benh nhan duac theo doi den tiiang thii 6 diiem 81,8%. Co 2 h^rih nhan mat lien lac hong Ian tai kham dau tien (3 thang), 1 b?nh nhan mat lien lac trong lan tai kham thii niii (6 tiiang).
Bdng 11: So'benh ididn tdi phdt tiong qud trinh theo doibenh
Then gian (thang) S6 tai phat moi (ca) Cqng tich luy (ca)
3 1/20 1/20
6 1/18 2/19 Trong qua trinh theo doi co 2 truong hop tai phat tiong tbng so 19 truong hop dugc theo doi 6 thang thii 6.
BAN LUAN
Ky thuat cat dot ngi soi buou bang quang nong bang Thulium YAG laser - day la loai mbi hien nay voi buoc song lien tuc 2.013nm gan vai can bling nuoc 1.910nm,dang nang lugng nay duoc vgn chuyen bang spi quang hoc tii may phat den thang vi tri can phau thuat<^' - la ky thuat tuong doi mai, tuy nhien khi ap dung khong qua kho khan cho cac phau thuat vien moi ciing nhu cae phau thuat vien co kinh nghiem cat dot bang dao dien don eye. Ngoai ra, hong nghien ciiu nay cb thoi gian mo trung binh 25,8 ± 8,4 phiit so voi cac tac gia dimg dien don cue nhu Chen Zhongf" (22,69 ± 8,34 phiit), hay Zhu Y"2) (24,9 ± 14,44 phiit) la tuong duong (p>0,05). Tii do chiing ta thay duoc phan nao tinh kha thi ciia phuong phap nay.
Hien nay, cat dot npi soi buou bang quang nong bang dien don cue dugc ap dung rpng rai va tro thanh tieu chuah. Tuy nhien, phuong phap nay van cho thay mgt so nhupc diem dang
Nghien cmi Y hpc \ Hpc TP. Hb Chi M i n h * Tap 18 * Sb 1 * 2014 quan tam, cy the dupe so sanh 6 bang ngay dudi
day:
O ^ c d i l m Thcri gian m6
tnjng binh (phut) PhanxathAn
kmh bit Thiing bang
quang Bom ri>a t>ar>g quang
s a u m 6 5 6 ngdy luu thong N O -
BQ So ngay n i m
vi^n Chiing toi
T m - TURBT 25.8 ± 8,4
0/22ca 0/22ca 0C2ca
1,6 ± 0 , 4
2,9 ± 0 , 7 X i s h u a n g ' " "
C M - T U R B T 18,36 ± 4 , 4 5
8(18lan)/51ca 4/51 ca 11/51ca
2,39 ± 0,77
4.27 ±1,01 Z h u Y " »
C M - TURBT 24,9 ± 14,4
7/111ca 3/111ca
2,46 ± 0,9
4,43 ± 1 . 0 6 P 0 218
<0,01
<0,01
<0,01
<0,01
<0,01 Glii dm. Sir dimg pliep kian Fislier dephdn tich bieii vai p<0,05 Id khac biet co y nghia thong ke, vai ung dung phan wiem SPSS 16.0 YAG: Yttrium Aluminum (iamet, Tm - TURBT: Tiinlium YAG laser transurethral resection of bladder tumor, CM - TURBT:(^nveiitioiial monopolar transurethral resection of bladder tumor
Qua do, chiing ta thay dugc moi quan tam la tai bien phan xa than kinh bit - thuong la vi tri hai thanh ben, vi no co the gay ra thiing bang quang (mpt bien chiing nang) va lam cho phau thuat vien khong the cat het buou. Voi nghien ciiu Clia chiing toi thi khong co truong hop nao bi phan xa than kinh bit (0/22ea) so voi nghien ciiu Clia Xishuangf"" 8(18^)/51ca hay eiia Zhu yoi) 7Allca (khac biet co y nghia voi p<0,01).
EJbng thoi voi nghien ciiu cua chiing toi khong CO horong hpp nao bi thiing bang quang (0/22ca), so sanh vdi nghien ciiu ciia Xishuangt^"! la 4/51ca hay Clia Zhu Y"-> 3/]llca (khac biet eo y nghTa voi p<0,01), dieu nay cho thay su an toan cao eiia phuang phap nay.
Ngoai ra, phuong phap con cho thay uu diem trong viec ram mau fhe hien qua; so truong hgp chay mau khong cam dugc la 0/22ca, can bam nia bang quang hau phau 0/22ca so voi ll/51ca Clia XJshuangii*"(khac biet eo y nghia voi p<0,01), thoi gian luu thong nieu dao - bang quang ngin hon 1,6 ± 0,4ngay so vdi Xishuangfi"^
2,39 ± 0,77ngay hay Zhu Yi-'2,46 ± 0,9ngay
(p<0,01), va thoi gian nam \nen cung it hon 2,9 ± 0,7ngay so voi Xishuang""' 4,27 ± l,01nga\' hay Zhu Yi^i 4,43 ± 1,06 ngay (p<0,01).
Ngoai ra, thong qua nghien ciiu ehiing toi co de danh gia mot phan hieu qua oia phuong phap cit dot buou bang quang chua xam lm bang Thulium YAG laser:
- Trong tat ca cac truong hgp chiing toi deu cat budu den lop co (thong qua quan sal dai the va ket qua giai phau b#nh), hau nhu deu cit het buou nhin thay dugc dac biet 6 nhiing vi tri kho c3t khi dimg dao dien nhu dinh bang quang hay thanh trudc bang quang.
thi voi ky thuat nay chiing toi co the thuc hien dugc. Va vai ky thuat nay, chiing toi co the cat trpn buou bang quang nong {en - bloc resedion) dieu nay phii hop voi nguyen tac phau thuat cho cac khoi budu ung thu.
- Khi theo doi co 2 truong hgp tai phat trong tong sb 19 tnrcmg hgp cho den thang thii 6 sau mb. Mpt truong hgp tai phat vao thing thii 3 a thanh trai bang quang 1 buou, truong hpp con lai tai phat vao thang thii 6 d vimg tam giac 1 buou va 6 thanh trai bang quang 1 buou. Ca 2 truong hgp deu khong nam tren vi tri eii (tiieo quan sat dai the khi cat dot ngi soi bo sung Ian thii hai) va dugc tien hanh cat dot ngi soi bb sung ngay sau do.
Tuy nhien, trong khi cat dot ngi soi chiing toi ehi sii dung anh sang trang thong thuong.Do do de danh gia toan dien hon ve hieu qua 6 mat ung thu hgc ciia phuong phap cat dot buou bang quang nong qua nga nJeu d^o vdi Thulium YAG Laser, can ap dung them anh sang tim huynh quang (fluorescence c}'Stoscopy) se lam tang kha nang phat hien CIS'' va phai theo doi benh nhan trong 5 nam sau phau thuat hay dai lau hon.
KETLUAN
Phuang phap cit dot qua nga nieu dao voi Thulium YAG laser dieu tri cho ung thu bang quang nong ket hpp bom vao bang quang mitomycin C sau ehu ky sau mb cho ket qua tbt Hpi Nghi Khoa Hpc Ky Thuat BV. Binh Dan 2014
Y Hpc TP. Hb Chi Minh * Tap 18 * Sb 1 * 2014 Nghien cmi Y hpc 90,9%, de thuc hien,c6 do an toan cao va hau
nhu khong co tai bien - bien chiing.
TAI LIEU THAM KHAO
1- Bab)uk H Burger M, Zigeuner R, Shanat S, Rhijn BV, Comperat E, Sylvester R Kaasinen E, Bohle A, Palou J, Roupret M (2013), "Guidelines on non - musde uivaave bladdercancer'', European Asodation of Urology, pp 4 - 4 2 2. Jones )S, Larchian WA (2012), " N o r - Musde Invasive
Bladder Cancer fTa, Tl and CIS)", Campbell - Walsh urology, lOthediaon, 81, pp 2335-2354
3 Jidilinski P et al (2003), "Hetyl aminolaevulinate fluorescence cysloscopj" a new diagnostic tool for photodiagioas of superfidal bladder cancer - a mullicenter study", J Urol, 170 ( l), pp 226-229.
4 Horatos DU Rosette JJMCH (1999), "Lasere in urolcgy", BJU Intemational,84,pp 204-211
3 Hermann TR, Liatsikos E, Nagele U, Traxer O, Mersebuiger AS (2011), "Guiddines tm Lasers and Technologies", Eur Urol, pp. 5 - 5 5
6 Messng EM (2007), "UrottieLal Tumors of the Biadda", Campbell - Walsh umlogy, 9th editioa Chapter 75.
7 Nieder AM, Meinbach DS, Kim SS, Soloway MS (2005), 'Transuretiiral biadda: tumor resectioa Intraoperative and postoperative complications in a residraicy setting", J Urol, 174, pp 2307-2309.
8. Nguyen Ky (1991). "Mpi so ket qua dieu bj ung Ihu nong o bang quang biing phuong phap cat ngi soi", Chuyen de N'goai lchoa,21(6), t r . 6 - 1 3
9 Vu Le Chuyen, Dao Quang Oanh (2012), "Dai cuong ve ung thu bang q u a n ^ ' , Phauthu^l cat bang quang, l . t r . l S - 6 1 . 10. Xishuang S, Deyong Y, and et al (2010), "Companng the
Safety and EfSdency of Conventional Monopdar, Plasmabnebc, and Holmium Laser Transurethral Reso*on of Pnmary Non - musde Invasive Bladder Cancer", Joumal of Endourology,24(1),pp 6 9 - 7 3 .
11. Zhong C, Guo S. Tang Y, Xia S (2010), "Oinical observahon on 2 micron laser fbr non - musde - mvasive bladder tumor treatment single - center experience". World J Urd, 28, pp.
157-161,
12. Zhu Y, Tiang X et al (2008), "Safety and Efficacy of Holmium laser resection fbr Primary Nonmusde - Invaave Bladder Cancer Veisus Transurethral Electroresechon: S m ^ - Center Expenence", Urology, 72. pp. 608-612.
Ngdy nhdn bdibdo: 31/10/2013 Ngdy phdn bi?n idi&n xet bdi bdo: 02/12/2013 Ngdy bdi bao diroc dang: 20/02/2014
