动脉化疗配合手术治疗膀胱癌的效果  

Clinical Effect of arterial chemotherapy and operation for bladder carcinoma

作　　者：赵丕显[1] 陈辉[1] 赵玉兰[2] 耿敬株[3] 王小民[1] 李长福[1] 徐万海[1] 乔忠杰[1] 

机构地区：[1]哈尔滨医科大学第三临床医学院泌尿外科,150040 [2]哈尔滨医科大学第三临床医学院病理科,150040 [3]哈尔滨医科大学第三临床医学院中心实验室,150040

出　　处：《中华泌尿外科杂志》2003年第7期451-453,共3页Chinese Journal of Urology

摘　　要：目的　评价动脉灌注化疗配合膀胱部分切除治疗膀胱癌的临床效果。　方法　膀胱癌患者 171例 ,均行膀胱部分切除 ,随机分 2组 :(1)术前动脉灌注化疗组 78例 ,行化疗前后进行膀胱镜观察 ;5 8例术后行病理形态学观察 ;12例术后行电镜超微结构观察 ;35例采用流式细胞术 (FCM )行肿瘤细胞核DNA含量测定。 (2 )术后动脉灌注化疗组 93例。膀胱癌单纯手术者 35例 ,测定DNA含量作为对照。所有病例随访 5年。　结果　术前灌注化疗 78例膀胱镜检查者 ,肿瘤消失 9例 ,肿瘤缩小≥ 5 0 % 4 9例 ,有效率 74 .3% (5 8/78)。 5 8例病理形态学观察 ,有效率 75 .9% (4 4 /5 8)。 12例电镜观察见肿瘤细胞明显受损。DNA含量测定 ,通过DNA指数 (DI)、增殖指数 (PI)、S期比率 (SFR)、异倍体率 4项指标的测定进行对比 ,在Ⅱ、Ⅲ级膀胱癌中 ,行动脉化疗与否 ,差异有显著性意义 (P <0 .0 5 )。 171例经动脉灌注化疗配合手术的病例 5年生存率 84 .2 % (14 4 /171) ,复发率 9.3% (16 /171)。　结论　动脉灌注化疗对膀胱癌有明显降级、降期、缩小病灶的作用 ,可降低复发率 ,提高生存率。Objective To evaluate the clinical efficacy of arterial chemotherapy and partial cystotomy for treatment of bladder carcinoma. Methods A total of 171 cases of the bladder carcinoma who would undergo partial cystotomy were randomly diviede into 2 groups:(1)78 patients received arterial chemotherapy before the operation;(2) 93 cases were treated with arterial chemotherapy after the operation.In addition,35 cases who underwent operation alone were selected for the DNA content detection by FCM as control group.All these cases were followed up for 5 years. Results Among the 78 cases with the cystoscopy,the tumors disappeared in 9 cases and the tumors shrank by half or more in 49 cases.The total effective rate was 74.3%(58/78).The pathological examination showed the effective rate was 75.9%(44/58).There was a remarkable change in the carcinoma cells by the electronic microscopy.DNA index,proliferation index,SFR and aneuploid rate were detected by FCM.In the cases of grades Ⅱ and Ⅲ bladder carcinoma there was a statistically significant difference ( P <0.05) between those with and those without arterial chemotherapy.The 5-year survival rate was 84.2%(144/171) for the patients who received arterial chemotherapy combined with operation. Conclusions The arterial chemotherapy was quite effective for degrading and subduing the bladder carcinoma and improving the survival rate.

关 键 词：动脉化疗 配合 治疗 膀胱癌 外科手术 

分 类 号：R737.14[医药卫生—肿瘤]