TURis-Bt术前膀胱灌注表柔比星治疗NMIUC的临床疗效观察  

Observation on the Clinical Effect of Preoperative Epirubicin Intravesical Chemotherapy Combined TURis-Bt in the Treatment of Non-muscle-invasive Urothelial Carcinoma of the Urinary Bladder

作　　者：齐磊[1,2] 卢洪凯[2] 都靖[2] 王梅利[2] 王永传[2] 刘海涛[3] 夏术阶[3] 

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261041 [2]潍坊市中医院泌尿外科,山东潍坊261041 [3]上海交通大学附属第一人民医院泌尿外科,上海200080

出　　处：《现代生物医学进展》2014年第16期3097-3101,共5页Progress in Modern Biomedicine

基　　金：潍坊市科学技术发展计划项目(20112028)

摘　　要：目的:探讨TURis-Bt术前膀胱灌注表柔比星治疗非肌层浸润性膀胱癌(NMIUC)的临床疗效。方法:选取2008年9月至2012年1月潍坊市中医院和上海交通大学附属第一人民医院泌尿外科收治的76例NMIUC患者,并将其随机分为观察组(TURis-Bt术前膀胱灌注表柔比星+术后常规灌注组)41例和对照组(TURis-Bt术后常规表柔比星膀胱灌注组)35例。灌注前将50mg表柔比星溶解于50ml 5%葡萄糖注射液,术前膀胱保留灌注30分钟后膀胱镜观察肿瘤组织及周围膀胱粘膜染色情况,将表柔比星橙染的膀胱粘膜活检并行TURis-Bt;对照组取瘤旁2 cm处及其他部位膀胱粘膜多点活检。比较两组的原位癌(CIS)、非典型性增生及腺性膀胱炎等病变检出率和术后肿瘤的复发率。结果:观察组患者瘤旁膀胱粘膜橙染56处,其中7处病理证实为膀胱原位癌、5处为非典型性增生、11处为腺性膀胱炎;对照组患者膀胱原位癌1处、非典型性增生3处、腺性膀胱炎2处,两组病变阳性率分别为41.1%(23/56)和13.4%(17/127),差异有显著统计学意义(P<0.01)。观察组与对照组术后2年内肿瘤复发率分别为10.3%(4/39)和35.3%(12/34),差异有统计学意义(P<0.05)。结论:TURis-Bt术前膀胱灌注表柔比星能提高NMIUC病变的早期检出率并降低肿瘤术后复发率。Objective： To evaluate the clinical effect of preoperative Epirubicin （Pharmorubicin） intravesical instillation before TURis-Bt in the treatment ofnon-muscle-invasive urothelial carcinoma ofthe urinary bladder （NMIUC）. Methods： 76 patients with NMIUC （Ta/T1） were randomly assigned to two groups： observation group （41 cases） was treated with TURis-Bt combined preoperative Epiru- bicin intravesical instillation （50mg in 50ml 5%GS） and postoperative instillation, the control group （35 cases） was treated with TURis-Bt combined postoperative intravesical instillation with Epirubicin. The positive rate of malignant diagnosis and the postoperative recurrence rate were compared between the two groups. Results： There were 56 positive results with 7 pathological sections proved to be CIS, 5 atypical hyperplasia and 11 glandular cystitis in the observation group, and the others were chronic cystitis. There were 1 case of CIS, 3 cases of atypical hyperplasia and 2 cases of glandular cystitis in the control group, the others were chronic cystitis. Two groups of lesions positive rates were 41.1% （23/56）and 13.4 % （17/127）. The significant difference was statistically significant （P〈0.01）. The 2-year tumor recurrence rates of observation group and control group were respectively 10.3%（4/39）and 35.3%（12/34）. Which was significantly lower in the observation group（P〈0.05）. Conclusion： Preoperative Epirubicin intravesical chemotherapy combined TURis-Bt could enhance the diagnostic rate of CIS and atypical hyperplasia and reduce the malignant recurrence of NMIUC.

关 键 词：表柔比星 TURis—Bt 膀胱灌注 非肌层浸润性膀胱癌 

分 类 号：R737.14[医药卫生—肿瘤]