铥激光联合吡柔比星治疗非肌层浸润性膀胱癌的临床研究  

The clinical study of thulium laser combined with intravesical instillation of pirarubicin in the treatment of non-muscle invasive bladder cancer

作　　者：平秦榕 颜汝平[1] 王剑松[1] 柯昌兴[1] 平艳芳 梁琪鑫 王宇扬 刘杨文易 王海峰 

机构地区：[1]昆明医科大学第二附属医院泌尿外科,云南昆明650101 [2]云南省曲靖市第二人民医院重症监护室,云南曲靖655000

出　　处：《国际泌尿系统杂志》2018年第1期42-45,共4页International Journal of Urology and Nephrology

基　　金：国家自然科学基金（81460384,81660422）,云南省科技厅面上项目（2015FB196）,云南省科技厅一昆明医科大学联合专项（2014FZ031）,云南省教育厅重点项目（20142072）,昆明医科大学2016年硕士研究生创新基金（2016S33）

摘　　要：目的 探讨经尿道铥激光剜除术联合吡柔比星膀胱灌注治疗非肌层浸润性膀胱癌的临床疗效.方法 回顾性分析2014年1月至2015年1月期间于本院诊治的67例NMIBC患者的临床资料,其中56例单发,11例多发,肿瘤直径0.5～2.7 cm,平均（2.1±0.4）cm,所有患者均采用经尿道铥激光剜除术治疗,术后接受吡柔比星即刻灌注治疗＋维持灌注治疗,定期回院复查,长期随访观察疗效.结果 67例均一次性成功剜除膀胱肿瘤,平均肿瘤剜除时间（17.3±6.8）min,术中出血量均不超过10 mL.无稀释性低钠血症、膀胱穿孔、闭孔神经反射出现.术后7例轻度血尿,2例尿路感染,1例尿道狭窄,对症治疗后好转.随访6～24个月,平均（13.6±3.4）个月,其中5例失访,8例复发（12.9％）,1例进展（1.6％）,13例在吡柔比星膀胱灌注化疗期间曾出现过Ⅰ级不良反应.结论 经尿道铥激光剜除术联合吡柔比星膀胱灌注治疗非肌层浸润性膀胱癌安全、有效,值得临床推广应用.Objective To investigate the clinical efficacy of transurethral thulium laser enucleation combined with intravesical instillation of pirarubicin in the treatment of non-muscle invasive bladder cancer.Methods The clinical data of 67 cases of non-muscle invasive bladder cancer who were treated in our hospital from January 2014 to January 2015 were analyzed retrospectively.Including 56 cases single tumor and 11 cases multiple tumors,the tumor diameter ranged from 0.5 to 2.7 cm [mean （2.1 ±0.4）em].All patients were treated by transurethral thulium laser enucleation combined with immediate postoperative instillation of pirarubicin and maintenance instillation of pirarubicin.Regular cystoscopy after operation and long-term follow-up was performed.Results All the operations were successfully enucleationed tumor with once time.The average time of tumor enucleation was （17.3 ± 6.8）min,the intraoperative blood loss was no more than 10 mL.There was no dilutional hyponatremia,bladder perforation,obturator nerve reflex were found in all patients.Postoperative complications included 7 cases of mild hematuria,2 cases of urinary tract infection,1 case of urethral stricture,and all patients were cured by symptomatic treatment.Followed up for 6 to 24 months with a mean of （13.6 ± 3.4） months.Five cases were lost to follow up,8 cases （12.9％） had recu-rrence,1 case （1.6％） had progression,13 patients had grade Ⅰ adverse reactions during intravesical instillation of pirarubicin.Conclusions The transurethral thulium laser enucleation combined with intravesical instillation of pirarubicin for treatment of non-muscle invasive bladder cancer is safe and effective,it is worthy of clinical application.

关 键 词：膀胱肿瘤 铥 表柔比星 

分 类 号：R737.14[医药卫生—肿瘤]