TURBt术前髂内动脉灌注化疗治疗T2、T3期肌层浸润性膀胱癌的疗效及其对患者术后生活质量的影响  

Clinical efficacy of transurethral resection of the bladder tumor combined with preoperative intra-arterial infusion chemotherapy and its effect on postoperative quality of life in patients with stage T_2 and T_3 muscle-invasive bladder cancer

作　　者：王震霆 罗曼[1] 汪智峰[2] 赵晓坤 

机构地区：[1]中南大学湘雅二医院泌尿外科,湖南长沙410000 [2]中南大学湘雅医学院附属海口医院泌尿外科,海南海口570208

出　　处：《海南医学》2017年第18期2951-2955,共5页Hainan Medical Journal

基　　金：海南省海口市重点科技计划项目(编号:2010-175)

摘　　要：目的探讨经尿道膀胱肿瘤切除术(TURBT)术前髂内动脉灌注化疗治疗T_2、T_3期肌层浸润性膀胱癌的疗效及其对患者术后生活质量的影响。方法选取中南大学湘雅二医院2012年12月至2015年2月收治的肌层浸润性膀胱癌患者共80例,按随机数表法分为对照组和观察组,每组40例。对照组患者单纯行TURBt,观察组患者在TURBt术前1周经双侧髂内动脉注入吉西他滨1 000 mg/m^2和卡铂300 mg/m^2。比较两组患者围手术期临床指标(手术时间、术中出血量、引流管留置时间、住院时间)。随访2年,比较两组患者的复发率,生存率以及不良反应(下泌尿道症候群、骨髓抑制、胃肠道反应),并以中文版SF-36生活质量评分表评估观察组术前、术后的躯体相关生活质量、心理相关生活质量。结果观察组患者的手术时间、术中出血量、导尿管留置时间及住院时间分别为(34.42±7.19)min、(25.76±4.58)mL、(8.21±2.43)d、(14.13±5.73)d,均明显优于对照组的(61.75±3.70)min、(52.32±7.43)mL、(6.94±3.20)d、(16.56±4.83)d,差异均有统计学意义(P<0.05);观察组患者的骨髓抑制发生率为7.50%,明显高于对照组的0,差异有统计学意义(P<0.05),但两组患者在下泌尿道症候群、胃肠道反应及总不良反应发生率方面比较差异均无统计学意义(P>0.05);观察组患者随访6个月、1年和2年时的复发率分别为2.50%、7.50%、15.00%,均明显低于对照组的15.00%、27.50%、32.50%,差异均有统计学意义(P<0.05);观察组患者1年、2年的无复发生存率及平均生存时间分别为92.50%、85.00%、(22.1±1.3)个月,均明显高于对照组的72.50%、67.50%、(18.3±1.6)个月,差异均有统计学意义(P<0.05),但1年、2年的总体生存率及平均生存时间两组比较差异均无统计学意义(P>0.05);观察组患者术后1个月的躯体相关生活质量评分及总分明显高于术前,差异均有统计学意义(P<0.05),而术后1个月心理相关生活质�Objective To investigate the clinical efficacy of transurethral resection of the bladder tumor（TURBt） combined with preoperative intra-arterial infusion chemotherapy in patients with stage T2 and T3 muscle-invasive bladder cancer（MIBC） and its effect on postoperative quality of life. Methods A total of 80 patients with MIBC of T2 and T3 stage in the Second Xiangya Hospital of Central South University from December 2012 to February 2015 were chosen as research subjects. The patients were randomly divided into control group（40 cases） and observation group（40 cases）. The control group only underwent surgical treatment by TURBt, and the patients in the observation group were injected with gemcitabine（1000 mg/m^2） and carboplatin（300 mg/m^2） via internal iliac artery within 1 week before TURBt. The perioperative clinical parameters（operation time, bleeding volume, indwelling time of the drainage tube and hospitalization time） were compared between the two groups. Patients from both groups were followed up for 2 years to compare recurrence rate, survival rate and incidence of adverse reactions（lower urinary tract symptoms, myelosuppression, and gastrointestinal reaction）. The preoperative, postoperative body-related quality of life and psychological quality of life were evaluated by using SF-36（Chinese version）. Results The operation time, bleeding volume, indwelling time of the drainage tube and hospitalization time in observation group were（34.42 ± 7.19） min,（25.76 ± 4.58） mL,（8.21±2.43） d,（14.13±5.73） d, significantly better than（61.75±3.70） min,（52.32±7.43） mL,（6.94±3.20） d,（16.56±4.83） d in the control group（P〈0.05）. The incidence of myelosuppression in observation group was 7.50%, which was significantly higher than 0 in the control group（P〈0.05）. There was no significant difference in the incidence of lower urinary tract syndrome, gastrointestinal reactions, and the total incidence of adverse reactions（P〉0.05）. The recu

关 键 词：经尿道膀胱肿瘤切除术 术前髂内动脉化疗栓塞 肌层浸润性膀胱癌 复发率 生存率 不良反应 生活质量 

分 类 号：R737.14[医药卫生—肿瘤]