3种膀胱灌注方案辅助治疗非肌层浸润性膀胱癌的疗效评估  

Study on the therapeutic effects of different schemes of intravesical instillation on non-muscle-invasive bladder cancer

作　　者：刘闯 张中沛 孙春山 周俊 李星 于乾 丁德刚 LIU Chuang;ZHANG Zhong-pei;SUN Chun-shan;ZHOU Jun;LI Xing;YU Qian;DINO De-gang(Department of Urology,People＇s Hospital of Zhengzhou University,Henan Prowicial People＇s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院泌尿外科,450003

出　　处：《现代泌尿生殖肿瘤杂志》2018年第5期274-277,共4页Journal of Contemporary Urologic and Reproductive Oncology

基　　金：河南省基础与前沿研究项目(152300410149)

摘　　要：目的评估表柔比星(EPI)+诱导灌注+维持灌注、EPI+即刻灌注+诱导灌注+维持灌注、铜绿假单胞菌-甘露糖敏感血凝菌毛株(PA-MSHA)+即刻灌注+诱导灌注+维持灌注3种方案对中高危非肌层浸润性膀胱癌(NMIBC)电切术后辅助治疗的有效性和安全性。方法回顾性分析182例经尿道膀胱肿瘤电切术后确诊为NMIBC患者的资料,依据术后灌注药物和灌注方法分为A组(EPI+诱导灌注+维持灌注)、B组(EPI+即刻灌注+诱导灌注+维持灌注)、C组(PAMSHA+即刻灌注+诱导灌注+维持灌注),各组按照肿瘤复发风险进一步分为高危组和中危组。随访2年,定期复查血尿常规、肝肾功能、心电图、泌尿系超声及膀胱镜检查,并记录膀胱癌复发情况以及膀胱灌注后不良反应的发生情况。结果 A、B、C组的不良反应发生率分别为42.86%(24/56)、38.24%(26/68)、18.97%(11/58);A、B两组不良反应发生率与C组比较,差异均有统计学意义(P=0.006、P=0.018)。A组高危患者与中危患者2年内肿瘤复发率分别为50.00%(10/20)、27.78%(10/36),B组高危患者与中危患者2年内肿瘤复发率分别为45.83%(11/24)、25.00%(11/44),C组高危患者与中危患者2年内肿瘤复发率分别为47.62%(10/21)、8.11%(3/37)。A、B两组高危患者2年内肿瘤复发率分别与C组高危患者比较,差异均无统计学意义(P=0.879、P=0.905);A、B两组中危患者2年内肿瘤复发率分别与C组中危患者比较,差异均有统计学意义(P=0.028、P=0.045)。结论 PA-MSHA+即刻灌注+诱导灌注+维持灌注辅助治疗NMIBC的不良反应发生率较低。对于高危NMIBC,3种灌注方式的疗效无差别;对于中危NMIBC,PA-MSHA+即刻灌注+诱导灌注+维持灌注效果最佳。Objective The efficacy and safety of three schemes of intravesical instillation on non muscle invasive bladder cancer （NMIBC） were evaluated. Methods One hundred and eighty two cases of NMBIC verified by pathology after TUNBT were classified into three groups according to different schemes of intravesical instillation： Group A, post operative regular instillation of cpiru bicin; Group B, immediate plus post operative intravesical instillation of cpirubicin; Group C, imme diate plus post operative intravesical instillation of l？seudomonas aeruginosa mannose sensitive he magglutinin （PA MSHA）. In each group, the patients were further divided into high risk and mid dle risk subgroup. All patients were followed up for 2 years. Urine and blood test, liver and renal function, cardiogram, urinary ultrasonography and cystoscopy were checked regularly in each follow up. And adverse reactions and recurrence of perfusion were observed. Results In the follow up pe riod of 2 years, the incidence of adverse reactions was 42.86% （24/56） in Group A and 38.24% （26/68） in Group B, 18.97% （11//58） in Group C. There was significant difference in the incidence of adverse reactions between the Group A and Group C, and there was also significant difference in the incidence of adverse reactions be tween the Group B and Group C. There were 10 （10/2@） and 10 （10/36） cases of tumor recurrence respectively in each sub group in Group A,11 （11/24） and 11 （11/4l） cases in Group B,10 （10/21） and 3 cases （3//37） in Group C. There was no significant differences in relapse rates of tumor recurrence in high risk patients among three groups in two years. However there was significant difference in relapse rates of tumor recurrence in middle risk patients among three groups in two years. Con- clusions The incidence of adverse events in PA MSHA was lower than the other schemes. Three schemes of intravesical instil lation have no difference in therapeutic effect on the high risk NMIBC. In middle risk NMIB

关 键 词：铜绿假单胞菌甘露糖敏感血凝菌毛株 表柔比星 非肌层浸润性膀胱癌 经尿道膀胱肿瘤电切术 膀胱灌注 

分 类 号：R737.14[医药卫生—肿瘤]