经尿道膀胱肿瘤电切术后应用吡柔比星两种膀胱内灌注方法治疗非浸润性膀胱尿路上皮癌的效果比较  

Comparison of the Outcome of Single and Multiple Intravesical Instillation of Pirarubicin after TURBT in the Treatment of Superficial Bladder Transitional Cancer

作　　者：王明琼 罗德康[2] 

机构地区：[1]四川省彭州市中医院外一科,四川彭州611930 [2]四川省第五人民医院泌尿外科,成都610031

出　　处：《肿瘤预防与治疗》2014年第2期77-80,共4页Journal of Cancer Control And Treatment

摘　　要：目的:观察经尿道膀胱肿瘤电切术(TURBT)后应用吡柔比星(THP)两种不同膀胱内灌注方法治疗非浸润性膀胱尿路上皮癌的效果及不良反应。方法:回顾性分析随访资料完整的TURBT治疗的非浸润性膀胱尿路上皮癌71例,术后应用吡柔比星30mg膀胱内灌注治疗。按不同的灌注方法分组,早期单次灌注组35例,手术结束后24小时内,单次膀胱灌注吡柔比星(THP);常规连续灌注组36例,术后1周开始膀胱灌注THP,每周1次连续8次后,每月1次连续10次。定期复查血常规、尿常规、肝肾功能;每3个月复查膀胱镜,2年后每6个月检查1次。结果:非浸润性膀胱尿路上皮癌71例,治疗后随访至少24个月,最长71个月,平均53个月;两组71例膀胱肿瘤复发共13例,合计复发率18.31%;多在术后2年内复发,占复发总例数的84.62%。单次灌注组复发率为20%,多次灌注组为16.67%,两组比较差异无统计学意义(P>0.05)。两组肝肾功能无明显不良反应。消化道反应、骨髓抑制均无Ⅲ级以上毒副反应。单次灌注组总的不良反应发生率为14.29%,多次灌注组为36.11%,两组比较差异有统计学意义(P<0.05)。结论:非浸润性膀胱尿路上皮癌经尿道电切术后应用吡柔比星(THP)膀胱内灌注治疗效果良好,早期单次灌注与常规连续灌注比较,复发率基本相同,可明显降低不良反应。非浸润性膀胱尿路上皮癌TURBT术后THP早期单次膀胱灌注值得临床推广。[ Abstract] Objective： To compare the efficacy and security of two different ways of pirarubicin instillations after transurethral resection of bladder tumor（ TURBT） in the treatment of superficial bladder transitional cancer. Methods：Data of 71 cases of superficial bladder transitional cancer accepted TURBT from Jan. 2004 to Jan. 2011 were analyzed retrospec-tively. All the cases were divided into 2 groups：35 cases received single intravesical instillation of 30mg pirarubicin within 24 hours after TURBT（group A ） and 36 were given multiple intravesical perfusions of pirarubicin（group B ） from one week after operation. 30mg pirarubicin was given once a week for totally 8 weeks followed by once a month for 10 times. The blood and urine routine test, liver and kidney function examination were conducted periodically. Cystoscopy was car-ried out every 3 months and was shifted to every 6 months after 2 years. Results：All patients were followed up from 24 to 71 months with an average of 53 months. The recurrence rate was 18. 31%（13/71） totally, and 84. 62% of the relapsed cases occurred during the first two years after the operation. The recurrence rate was 20% in group A and 16. 67% in group B without significant difference. No obvious liver and kidney injury occurred. Over III grade gastrointestinal reaction and myelosuppression were not observed. The incidence of adverse reaction in group A （14. 29%） was significantly lower than that of group B（36. 11%）（P＆lt;0. 05）. Conclusion：Instillation of Pirarubicin after TURBT in the treatment of superficial bladder transitional cancer can get good clinical outcomes. Comparing with the routine continuous instillation, the early single instillation has similar recurrence rate but obviously re-duced side effects and is worthy of clinical application.

关 键 词：非浸润性膀胱尿路上皮癌 经尿道膀胱癌电切术 吡柔比星 膀胱灌注 

分 类 号：R737.14[医药卫生—肿瘤] R730.56[医药卫生—临床医学]