绿激光汽化术与膀胱癌电切术联合吡柔比星灌注化疗的队列研究  

Transurethral green laser vaporation versus traditional transurethral bladder tumor resection combined with Pirarubicin intrabladder irrigation chemotherapy in treatment for non-muscular invasive bladder urothelial carcinoma:a cohort study

作　　者：杨清荣[1] 马莉[1] 但丹[1] 刘玲[1] 邬惠林 苟淼[1] 

机构地区：[1]四川大学华西医院泌尿外科,四川成都610041

出　　处：《西部医学》2016年第2期181-184,共4页Medical Journal of West China

基　　金：国家自然科学基金青年基金(81200551)

摘　　要：目的 评价联合绿激光汽化术和膀胱癌电切术后即刻膀胱灌注吡柔比星（THP）预防肿瘤复发的有效性和安全性.方法 纳入标准：连续纳入2013年1月～2015年3月期间,在四川大学华西医院住院的非肌层浸润性膀胱移行上皮癌患者.排除标准：肌层浸润性膀胱癌,复发膀胱癌,膀胱腺癌、鳞癌,合并有凝血功能障碍,心肺功能障碍不能接受全麻的患者,以及不愿意入组研究的患者,存在严重的膀胱穿孔、大量血尿等并发症而不宜行术后即刻膀胱灌注的患者,和术后病理结果为肌层浸润性的患者.将纳入的患者按入院号分组,试验组采用绿激光汽化术后THP即刻膀胱灌注（术后24小时内）续以8周诱导灌注,每周1次,再续以1年持续灌注,每月1次;对照组采用TURBT术,术后灌注方法同试验组.主要结局指标为膀胱癌复发和术后并发症,并发症按照国际通用不良事件标准4.0版本记录.结果 共纳入176例患者,试验组84例,对照组92例.两组患者中位随访时间为15（12～33）个月,试验组复发率显著低于对照组（x2 =4.966,P=0.026）.试验组中23例患者发生尿路刺激征、血尿等不良反应,对照组中20例患者发生不良反应,差异无统计学意义（P=0.384）.结论 浅表性膀胱癌绿激光汽化术后THP膀胱灌注,与传统电切联合THP灌注比较,能显著降低膀胱癌的复发率且不增加术后并发症的发生和严重程度,临床推荐应用.Objective To assess the safety and efficacy of green laser vaporation combined with Pirarubicin in pre- venting the recurrence of non-muscular invasive bladder tumor. Methods Inclusive criteria was consecutive patients ad- mitted during January 2013 to March 2015 diagnosed non-muscular invasive bladder cancer. Exclusive criteria were pa- tients proven to be muscular invasive bladder cancer, recurrent bladder cancer, squamous cell carcinoma, adenocarcino- ma, patients who could＇t receive general anesthesia for organic dysfunction, patients who were with coagulation disor- ders, patients who were improper to receive immediate bladder irrigation chemotherapy for the presence of severe compli- cations such as perforation and lots of hematuria. The enrolled patients were assigned to the two groups according to their admittion number. The observation group were treated by green laser vaporation followed by immediate Pirarubicin intra- bladder chemotherapy, early irrigation of 8 weeks qw, and continous irrigation of 1 year qm. The controlled group was treated by traditional transurethral bladder tumor resection, followed by the same regimen as the observation group. Pri- mary outcomes were rate of recurrence and postoperative complications which were recorded by international common ter- minology criteria adverse events 4.0 edition. Results 176 patients, 84 in observation group and 92 in controlled group, were included in this study. The median follow up time was 15 months（12~33） and the recurrence rate was significantly lower in observation group （ 2 = 4. 966, P= 0. 026）. The complications were all found of in 1 or 2 degree and the rate was comparable between groups. Conclusion green laser vaporation combined with Pirarubicin intrabladder irrigation chomo-therapy is recommended for non-muscular invasive bladder urothelial carcinoma for the better efficacy and comparable safety.

关 键 词：非肌层浸润性膀胱癌 绿激光膀胱肿瘤汽化术 吡柔比星 膀胱灌注 安全性和有效性 

分 类 号：R737.14[医药卫生—肿瘤]