卡介苗、铜绿假单胞菌交替膀胱灌注预防高危非肌层浸润性膀胱癌术后复发的疗效及安全性  

The efficacy and safety of alternative intravesical instillation of BCG and pseudomonas aeruginosa to prevent recurrence of high-risk non-muscular invasive bladder cancer

作　　者：张梦菲 赵秋香 孙囡囡 王禾 付强 ZHANG Mengfei;ZHAO Qiuxiang;SUN Nannan;WANG He;FU Qiang(Department of Urology,Second Hospital of Air Force Medical University,Shaanxi Xi'an 710038,China.)

机构地区：[1]空军军医大学第二附属医院泌尿外科,陕西西安710038

出　　处：《现代肿瘤医学》2023年第5期890-894,共5页Journal of Modern Oncology

基　　金：国家自然科学基金面上项目(编号:81772745);陕西省重点研发计划一般项目—社会发展领域基金(编号:2020SF-124)。

摘　　要：目的:分析卡介苗(bacillus calmette guerin, BCG)、铜绿假单胞菌(pseudomonas aeruginosa, PA)-MSHA菌毛株交替膀胱灌注对高危非肌层浸润性膀胱癌(non-muscular invasive bladder cancer, NMIBC)术后患者的肿瘤复发率、不良反应及灌注前后患者生活质量的影响。方法:回顾性分析我科自2017年10月至2019年10月收治的120例诊断为膀胱癌并行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor, TURBT),且术后病理提示为高危NMIBC的患者。随机分为两组,分别为BCG、PA-MSHA交替灌注组(实验组,60例)及吉西他滨单药灌注组(对照组,60例)。术后2年不同阶段对患者进行随访,针对两组患者治疗后肿瘤复发率、不良反应及灌注前后对患者生活质量的影响进行比较分析。结果:经过术后12个月的灌注治疗,两组患者肿瘤复发率比较无统计学差异(P> 0.05);灌注18个月及24个月,实验组肿瘤复发率(11.67%、15.00%)均低于对照组(26.67%、33.33%),差异有统计学意义(P<0.05)。实验组交替灌注PA-MSHA后不良反应较少,发热发生率为1.30%,恶心呕吐发生率为0.40%,膀胱刺激征发生率为3.70%,血尿发生率为0.40%;对照组在使用吉西他滨灌注后发热发生率为3.15%,恶心呕吐发生率为0.90%,膀胱刺激征发生率为13.52%,血尿发生率为1.10%。实验组使用PA-MSHA灌注后与对照组相比,发热发生率和膀胱刺激征发生率差异均有统计学意义(P<0.05);恶心呕吐发生率、血尿发生率两者并无明显差异,不具有统计学意义(P>0.05)。实验组治疗后12个月、24个月的生活质量评分均高于对照组,差异有统计学意义(P<0.05)。结论:高危NMIBC术后使用BCG、PA-MSHA交替膀胱灌注可有效预防NMIBC术后肿瘤复发,可在降低膀胱灌注不良反应发生率的同时提高患者的耐受性及生活质量。Objective:To analyze the effect of alternative intravesical instillation of bacillus calmette guerin(BCG) and pseudomonas aeruginosa(PA)-MSHA on the tumor recurrence rate, adverse reactions and quality of life of patients with high-risk non-muscular invasive bladder cancer(NMIBC) after operation.Methods:120 patients diagnosed as bladder cancer and treated with transurethral resection of bladder tumor(TURBT) from October 2017 to October 2019 in our department were retrospectively analyzed, and the postoperative pathology showed that they were high-risk NMIBC.They were randomly divided into two groups: BCG and PA-MSHA alternating perfusion group(experimental group, 60 cases) and gemcitabine single drug perfusion group(control group, 60 cases).The patients were followed up at different stages two years after operation, and the recurrence rate, adverse reactions and the impact on the quality of life of the patients before and after perfusion were compared and analyzed.Results:After 12 months of perfusion treatment, there was no significant difference in the recurrence rate between the two groups(P>0.05).At 18 and 24 months of perfusion, the recurrence rate of the experimental group(11.67%,15.00%) was lower than that of the control group(26.67%,33.33%),and the difference was statistically significant(P<0.05).The experimental group had fewer adverse reactions after alternative perfusion of PA-MSHA,with the incidence of fever(1.30%),nausea and vomiting(0.40%),bladder irritation symptoms(3.70%),hematuria(0.40%),and the control group had fever(3.15%),nausea and vomiting(0.90%),bladder irritation symptoms(13.52%),and hematuria(1.10%).There was significant difference in the incidence of fever and bladder irritation(P<0.05),but there was no significant difference in the incidence of nausea and vomiting and hematuria(P>0.05).The scores of quality of life in the experimental group at 12 and 24 months after treatment were higher than those in the control group, and the difference was statistically significant(P<0.05).Conclusion

关 键 词：铜绿假单胞菌 卡介苗 膀胱灌注 高危非肌层浸润性膀胱癌 吉西他滨 

分 类 号：R737.14[医药卫生—肿瘤]