根治性经尿道绿激光汽化术联合化疗治疗肌层浸润性膀胱癌的临床观察  

Clinical observation of radical transurethral photoselective vaporization of bladder tumours combined with chemotherapy in treating muscle invasive bladder cancer

作　　者：李昭夷[1] 侯瑞鹏[1] 李健[1] 

机构地区：[1]天津市人民医院泌尿外科,300121

出　　处：《中华泌尿外科杂志》2015年第7期487-489,共3页Chinese Journal of Urology

摘　　要：目的 探讨应用根治性经尿道膀胱肿瘤绿激光汽化术（radical transurethral photoselective vaporization of bladder tumours,RPVBT）联合化疗治疗肌层浸润性膀胱癌的疗效和安全性.方法 2010年9月至2012年9月收治的肌层浸润性膀胱癌患者34例,男27例,女7例.年龄56 ～ 82岁,平均70岁.肿瘤单发20例,多发14例.肿瘤直径1.5 ～4.0 cm,平均2.5 cm.肿瘤位于膀胱三角区4例、两侧壁31例、后壁6例、顶壁2例、前壁2例、膀胱颈部5例.术前均经膀胱镜活检,病理诊断为乳头状尿路上皮癌.MRI检查临床分期T2a～T2b期.因患者拒绝或高龄、合并较重内科疾病等难以耐受根治性膀胱切除术,采用RPVBT术.术中汽化切除肿瘤至膀胱壁外脂肪层.术后给予吉西他滨联合顺铂的全身化疗和表柔比星膀胱灌注化疗.结果 本组34例手术均顺利完成,手术时间30.5 ～ 69.0 min,平均49.2 min.术中冲洗液量5.9～10.7 L,平均8.3L.术中无明显出血,术中、术后均无严重手术并发症.术后病理诊断为浸润性尿路上皮细胞癌,病理分级：低级别15例,高级别19例.随访12 ～ 36个月,平均21个月.9例（26.5％）复发,首次复发时间为术后3～ 20个月,中位时间11个月.其中2例行根治性膀胱切除术,余7例再次行RPVBT.3例复发患者死于膀胱癌转移,余31例存活.结论 RPVBT联合化疗治疗局部肌层浸润性膀胱癌创伤小、出血少、安全性高,具有一定疗效,是高危、高龄或不愿意接受根治性膀胱切除术患者可以选择的治疗策略.Objective To explore the safety and clinical efficacy of radical transurethral photoselective vaporization of bladder tumours （RPVBT） combined with chemotherapy in the treatment of muscle invasive bladder cancer.Methods Collected during Sept.2010 to Sept.2012,a total of 34 patients with muscle invasive bladder cancer who refuse or older,merge the heavier medical disease,difficult to tolerate radical cystectomy.Using RPVBT,vaporization resection to the bladder wall fat layer,postoperatively systemic chemotherapy of gemcitabine combined cisplatin and bladder perfusion chemotherapy of pharmorubicin.The operation time、the first recurrent time and recurrent rate,and the survival rate were measured.Results Operation are completed smoothly,operating time is 30.5-69.0 min and average 49.2 min,intraoperative rinses quantity is 5.9-10.7 L and average 8.3 L.Intraoperative no obvious bleeding,intraoperative no serioue complications,postoperative pathological diagnosis is invasive epithelial cell carcinoma of the urinary tract,pathology classification：low level 15cases,the high level 19 cases.Followup of 12 to 36 months,an average of 21 months,9 cases of recurrence,2 cases underwent radical cystectomy,7 cases again RPVBT,the first tumor recurrence time 3-20 months,11 months and the median time to relapse recurrence rate 26.5% （9/34）,3 cases of relapses diedof bladder cancer metastasis,31 cases of survival.Conclusion Treatment of RPVBT combination chemotherapy in patients with locally invasive bladder cancer,small trauma,less bleeding,high safety,have certain curative effect,It could be a effective treatment strategy for patients of high-risk elderly or unwilling to accept Radadical cystectomy.

关 键 词：肌层浸润性膀胱癌 根治性 绿激光汽化术 

分 类 号：R737.14[医药卫生—肿瘤]