经尿道膀胱肿瘤切除术联合髂内动脉栓塞化疗治疗高龄高危浸润性膀胱癌的临床效果  

TURBt combined with internal iliac artery embolization in treatment of elderly invasive bladder cancer patients with high risk

作　　者：黄金明[1] Jin-ming Huang(Department of Urology, the First Affiliated Hospital of Nanyang Medical College,Nanyang, Henan 473058, China)

机构地区：[1]南阳医学高等专科学校第一附属医院泌尿外科,河南南阳473058

出　　处：《中国内镜杂志》2017年第3期99-103,共5页China Journal of Endoscopy

摘　　要：目的探讨经尿道膀胱肿瘤切除术(TURBt)联合髂内动脉栓塞化疗治疗因高龄高危不能耐受根治性膀胱全切的肌层浸润性膀胱癌的临床疗效。方法对2010年2月-2016年5月26例经B超、CT及膀胱镜检查确诊为肌层浸润性膀胱癌但不能耐受根治性膀胱全切的高龄高危患者采用TURBt联合髂内动脉栓塞及灌注化疗进行治疗,TURBt可于灌注化疗前或灌注化疗后进行,具体视肿瘤大小及患者病情而定。结果 26例患者手术及髂内动脉栓塞化疗均顺利完成。术前栓塞化疗16例,术后栓塞化疗1次18例,2次9例,3次5例。术后7例复发者再次行TURBt,2例2次复发,行第3次TURBt,复发者再次术前栓塞化疗1次3例。6例合并前列腺增生(BPH)致排尿困难者同时行经尿道前列腺电切术(TURP)。未发生与手术相关的严重并发症,无围手术期死亡。术后病理报告均为肌层浸润性移行细胞癌。灌注化疗期间未发生骨髓抑制、贫血和肝肾功能损害等严重毒副作用。术后随访3个月~6年,2年内死亡2例,2~5年内死亡4例,18例生存至今,2例失访。结论对于肌层浸润性膀胱癌的高龄高危患者,TURBt联合髂内动脉栓塞化疗,具有微创、痛苦小、并发症少的特点,避免了根治性膀胱全切术带来的高风险性,以及由于尿流改道而造成的生活质量下降,有效延缓了病情的进展。方法安全、疗效可靠。Objective To investigate the clinical effect of transurethral resection of bladder tumor(TURBt)combined with internal iliac artery embolization in treatment of elderly invasive bladder cancer patients with highrisk.Method From February2010to May2016,26cases by ultrasonography,CT and cystoscopy were diagnosedwith muscle invasive bladder cancer but high-risk patients cannot tolerate radical cystectomy with transurethralresection of bladder tumor(TURBt)combined with internal iliac artery infusion chemotherapy and embolizationtreatment,TURBt could be used in chemotherapy before or after chemotherapy,specific depending on the sizeof the tumor and the patient may be.Result The operation and internal iliac artery embolization chemotherapyin26patients were successfully completed.Preoperative embolization in16cases,18cases of postoperativechemoembolization1times,2times in9cases,3times in5cases,.Among them,7cases relapsed again,TURBt,2cases of recurrence,third cases of TURBt,3cases of recurrence of preoperative embolization chemotherapy1times.Transurethral resection of the prostate(TURP)in6patients with benign prostatic hyperplasia(BPH)and transurethralresection of the prostate.No serious complications associated with surgery,no perioperative death.Postoperativepathological report was a muscle invasive transitional cell carcinoma.No bone marrow suppression,anemia,liver andrenal function damage and other serious side effects were not occurred during the chemotherapy.After the operation,the patients were followed up from3months to6years,2cases died within2years,4cases died within2to5years,18cases were alive,2cases were lost to follow-up.Conclusion For patients at high risk for muscle invasive bladdercancer,TURBt combined with internal iliac artery embolization chemotherapy,minimally invasive,less pain,lesscomplications,to avoid the high risk of radical cystectomy and caused by urinary diversion due to the decline in thequality of life,can delay the disease progression.Safety and efficacy.

关 键 词：膀胱肿瘤 高龄高危 经尿道膀胱肿瘤切除术 动脉栓塞 灌注化疗 

分 类 号：R737.14[医药卫生—肿瘤]