肌层浸润性膀胱癌保留膀胱手术后不同辅助治疗方法的疗效评价  

Efficacy of combined therapy for muscle invasive bladder cancer with retained bladder

作　　者：张国辉[1] 王金萍[2] 郑清友[1] 李志辉[1] 关亚伟[1] 张勇[1] 朱立夏[1] 

机构地区：[1]北京军区总医院泌尿外科,北京100700 [2]北京军区总医院药理科,北京100700

出　　处：《现代泌尿外科杂志》2013年第6期557-561,共5页Journal of Modern Urology

摘　　要：目的探索保留膀胱手术＋动脉灌注化疗＋膀胱内灌注化疗治疗肌层浸润性膀胱癌的临床疗效。方法对经尿道膀胱肿瘤电切或膀胱部分切除术后确诊为肌层浸润性膀胱癌（T2N0M0）的168例患者，充分向患者及其家属介绍病情和治疗建议，对拒绝或不适合膀胱全切的患者经患者及其家属同意，均采用保留膀胱治疗方法，分为3个治疗组：（1）综合治疗组：68例，术后采用动脉灌注化疗＋膀胱灌注化疗；（2）动脉灌注化疗组：48例，术后仅采用动脉灌注化疗；（3）膀胱灌注化疗组：52例，术后仅采用膀胱灌注化疗。结果168例膀胱癌（T2N0M0）患者，观察期内，综合治疗组患者中92．65％（63／68）无复发及转移，7．45％（5／68）分别在术后6、8、12、18、20个月复发，2．94％（2／68）在术后6、13个月出现全身多处转移死亡，11．76％（8／88）非膀胱癌导致死亡。动脉灌注化疗组患者中79．17％（38／48）无复发及转移，20．83％（10／48）在术后1～28个月复发，4．17％（2／48）在术后9、18个月出现全身多处转移死亡，12．50％（6／48）非膀胱癌导致死亡。膀胱灌注化疗组患者中44．23％（23／52）无复发及转移，55．77％（29／52）在术后1～24个月复发，15．38％（8／52）在术后10～96个月转移而死亡，13．46％（7／52）非膀胱癌导致死亡。3组疗效按复发率任何两组间比较，均有统计学差别（P均〈0．05）。3组疗效按癌性死亡率任何两组间比较，综合治疗组与动脉灌注化疗组相比，差异无统计学意义（P均〉O．05）；综合治疗组、动脉灌注化疗组均低于膀胱灌注化疗组，差异均有统计学意义（P均〈O．05）。3组患者分组治疗后非膀胱癌导致死亡率任何两组间比较，无统计学差异（P均〉o．05）。结论肌层浸润性膀胱癌（T2N0M0）患者，采用保留膀胱手术＋髂内动脉灌�Objective To investigate the efficacy of combination of operation and bladder infusion chemotherapy and intra-arterial chemotherapy for bladder cancer with muscle invasion. Methods we collected 168 patients diagnosed as muscle invasive bladder cancer （T2N0M0） after TURBT or partial resection of the bladder. After informed consent, we divided the patients into 3 treatment groups. Group A included 68 cases using intra-arterial infusion and intravesical chemotherapy after surgery. Group B had 48 cases receiving intra-arterial infusion after surgery. Group C,consisted of 52 cases treated with intra- vesical chemotherapy after surgery. Results During the follow-up, in Group A, 92.65% （63/68） patients had no recurrence and metastasis, and 7.35% （5/68） recurred 6, 8, 12, 18 and 20 months postoperatively. 2.94% （2/68） patients died of metastasis 6 or 13 months after surgery. 11.76% （8/68） patients died of other diseases. In Group B, 79.17% （38/48） patients had no recurrence and metastasis, and 20.83% （10/48） recurred 28 months after surgery. 4.17% （2/48） patients died of systemic metastases 9 or 18 months postoperatively. 12.50% （6/48） patients died of other diseases. In Group C, 44.23% （23/52） patients had no recurrence and metastasis, and 55.77% （29/52） recurred 28 months after surgery. 15.38% （8/52） patients died of metastasis 10 to 96 months after surgery. 13.46 % （7/52） patients died of other diseases. The efficacy rates in the three groups were statistically different （P〈O. 05） and the relapse rate of Group A, 7.35%% ,was the lowest. Compared with Group C, the efficacy rates of Group A and B were lower, with statistical difference. Compared with Group A, the efficacy rate of Group B was not statistically significant （P〉0. 025）. The cancer mortality rate in the three groups was statistically significant （P = 0. 020）, which of Group A was the lowest, statistically different from that of Group C, but not from that of Group B （P〉 0. 025）. Non-can

关 键 词：肌层浸润性膀胱癌 保留膀胱手术 动脉内灌注化疗 膀胱内灌注化疗 

分 类 号：R737.14[医药卫生—肿瘤]