术后即刻+短程膀胱灌注方案预防非浸润性膀胱癌术后复发应用体会  

The Experience of Immediate Intravesieal Instillation Combined with Short-Term Intravesical Instillation after Operation for Preventing Postoperative Recurrence of Non Invasive Bladder Cancer

作　　者：蒋华[1] 卜强[1] 孙传玉 夏国伟 吴爱斌[1] 吴云[1] 曾明辉[1] 

机构地区：[1]丹阳市人民医院泌尿外科,江苏丹阳212300 [2]复旦大学附属华山医院泌尿外科,上海200040

出　　处：《泌尿外科杂志（电子版）》2017年第1期36-38,41,共4页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的探讨运用术后即刻及短程膀胱灌注方案预防非浸润性膀胱癌术后复发的疗效。方法对丹阳市人民医院及复旦大学附属华山医院泌尿外科自2012年至2015年收治的39例(I组)病理证实为非浸润性膀胱癌行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBt)的患者,术后用蒸馏水膀胱内冲洗后,即刻将40mg吡柔比星溶于40ml蒸馏水进行灌注,维持2小时后排出,术后7天开始规律每周1次共灌注8周,每月1次维持灌注8个月后结束。2012年之前的非浸润性膀胱癌患者45例(Ⅱ组),术后7天始同剂量吡柔比星规律常规膀胱灌注,每周1次共灌注8周,每月1次维持灌注12个月。比较Ⅰ、Ⅱ组患者膀胱肿瘤复发率、不良反应。结果二组进行常规膀胱镜复查随访,随访8~56个月,平均35.9个月,Ⅰ组4例膀胱肿瘤复发,Ⅱ组13例复发,差异有统计学意义;不良反应包括肉眼血尿及尿路刺激征等,两组相比较差异具有统计学意义。结论非浸润性膀胱癌TURBt术后运用优化的膀胱灌注方案(即刻+短程使用吡柔比星)灌注化疗,可以显著降低膀胱肿瘤复发率,减轻不良反应,在中低危非肌层浸润性膀胱癌患者中优点尤其明显,可作为推荐方案使用。Objective To investigate the efficacy of immediate intravesical instillation cmbined with short-term maintained intravesical instillation chemotherapy of pirarubicin after operation on preventing postoperative recurrence of non invasive bladder cancer. Methods 39 cases in Department of Urology of Danyang People's Hospital and Huashan Hospital Affiliated to Fudan Universit in the first group were managed by intravesical instillation of pirarubicin after transurethral resection of bladder tumor( TURBt) within from 2012 to 2015,followed by regular intravesical instillation of pirarubicin 7 days after operation,once a week after 8 weeks,once a month perfusion for 6 months. The regular intravesical instillations of pirarubicin were managed to the patients of the second group( 53 cases before the year of 2012) from 7 days after operation,once a week after 8 weeks,once a month perfusion for 12 months. All patients were followed up with regular cystoscopy examination,the recurrence rates and side effects、adverse reactions and costs between two groups were examined. Results After 35. 9months( 8 ~ 56months) fellow-up,the recurrence rate of first group was 10. 3%,and that of control group was20. 0%. There is a markedly difference between two groups. The incidence of side effects between two groups was difference. Conclusions The scheme optimization of postopertative infusion( immediate intravesical instillation combined with short-term maintained intravesicsl instillation chemotherapy of THP) after TURBt can significantly decrease the recurrence of non invasive bladder cancer,reduce adverse reactions,the advantages of low and medium risk non muscle invasive bladder cancer patients are particularly obvious,recommend for clinical use.

关 键 词：非浸润性膀胱癌 膀胱肿瘤 肿瘤复发 吡柔比星 

分 类 号：R737.14[医药卫生—肿瘤]