超选择膀胱动脉化疗栓塞治疗晚期膀胱癌伴出血的疗效分析  

Efficacy of superselective bladder arterial chemoembolization for the treatment of advanced bladder cancer with bleeding

作　　者：游建雄[1] 王精兵[1] 赵庆 郑连洲[1] 范新东[1] 苏立新[1] 温明哲 杨西涛[1] YOU Jianxiong;WANG Jingbing;ZHAO Qing;ZHENG Lianzhou;FAN Xindong;SU Lixin;WEN Minzhe;YANG Xitao(Department of Interventional Therapy, Affiliated Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 201999, China)

机构地区：[1]上海交通大学医学院附属第九人民医院介入科

出　　处：《介入放射学杂志》2019年第7期647-651,共5页Journal of Interventional Radiology

摘　　要：目的探讨经导管膀胱动脉化疗栓塞治疗晚期膀胱癌伴出血的临床疗效及安全性。方法2005 年 6 月至 2018 年 3 月共收治 32 例晚期膀胱癌伴出血患者,其中移行细胞癌(TCC)30 例,鳞状细胞癌(SSC)2 例。所有患者均行超选择膀胱动脉插管,先行顺铂+吡柔比星灌注化疗,再以碘化油-吡柔比星乳剂以及明胶海绵颗粒栓塞肿瘤血管,疗程间隔时间 1~3 个月。结果 32 例患者共行 98 次栓塞治疗(平均每例 3.1 次),其中 29 例(90.6%)首次术后 48 h 内完全止血,另外 3 例再次介入治疗后完全止血。平均随访 20.2(6~72)个月,半年生存率为 93.8%(30/32);22 例(68.8%)患者血尿未复发。 10 例患者随访期间血尿复发,其中 8 例再次栓塞,另外 2 例保守治疗;16 例患者(50.0%)在 TACE 之前需要输血平均 3.5(1~8)单位,TACE 后仅 3 例(9.4%)需再次输血。术后 2 周血红蛋白水平由术前的(85.2±16.9) g/L 明显增高至(102.1±17.4) g/L(P<0.001)。随访期间无与介入相关的严重并发症,轻度不良反应如发热、恶心和尿路刺激征,均在 3~7 d 后消失。本组患者末次治疗后 1 个月 CT 或 MRI 影像资料显示,病灶完全缓解(CR)9 例,部分缓解(PR)18 例,稳定(NC)3 例,疾病进展(PD)2 例,总有效率(CR+PR)为 84.4%,疾病获益率(CR+PR+NC)为 93.8%。结论对于晚期膀胱癌伴出血患者,采用碘油-化疗药乳剂超选择性栓塞膀胱动脉是一种安全有效的方法。Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) via bladder artery in treating advanced bladder cancer with hemorrhage. Methods From June 2005 to March 2018, a total of 32 patients with advanced bladder cancer complicated by hemorrhage were admitted to authors' hospital. Pathological types included transitional cell carcinoma (TCC, n =30) and squamous cell carcinoma (SCC, n =2). Superselective catheterization of bladder artery was performed in all patients. Infusion chemotherapy with cisplatin plus pirarubicin was carried out, which was followed by embolization of tumor-feeding vessels with lipiodol- pirarubicin emulsion. The interval of treatment course was 1-3 months. Results A total of 98 embolization procedures were performed in 32 patients (mean of 3.1 times per case). In 29 patients (90.6%) complete hemostasis was achieved within 48 hours after initial embolization, in the other 3 patients complete hemostasis was obtained after the second embolization. The mean follow- up period was 20.2 months (6-72 months), the 6- month survival rate was 93.8%(30/32), and no recurrence of hematuria was observed in 22 patients. During the follow - up period 10 patients had recurrence of hematuria, 8 of them received re- embolization and 2 were treated conservatively. Before TACE 16 patients (50%) needed a blood transfusion with a mean amount of 3.5 units (1-8 units), and after TACE only 3 patients (9.4%) needed another blood transfusion. The 2- week postoperative hemoglobin level was significantly increased from preoperative (8.52±1.69) g/dL to (10.21±1.74) g/dL (P<0.001). During the follow-up period no intervention- related complications occurred, mild adverse reactions such as fever, nausea and urinary tract irritation could disappear after 3 -7 days. In this group of patients CT or MRI performed one month after embolization treatment showed that complete remission (CR) of lesion was observed in 9 patients, partial remission (PR) in 18 patients, stable disease (

关 键 词：超选择性膀胱动脉栓塞 晚期膀胱癌 顽固性血尿 碘化油乳剂 

分 类 号：R737.14[医药卫生—肿瘤]