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TUR是表浅性膀胱肿瘤的首选治疗,但2～5年内复发率高达50～70％,而且20％的复发者将有肿瘤分级和/或分期增高。有原位癌的患者复发率更高。近年已采用预防性腔内化疗防止肿瘤复发。丝裂霉素C(MMC)是最有效的药物之一,但灌药剂量、时间、次数尚不统一。作者采用随机前瞻试验评价灌注MMC半小时和1小时对复发率、复发间隔、肿瘤恶化的影响。方法及结果 TUR 2周后开始膀胱灌注MMC,每次40mg/40mlNS,每周1次,连续8用后改为每月1次,连续4次。治疗70例患者,其中14例因严重毒性反应退出治疗,其余56例分为2组。灌注半小时组28例,随访15.7月,10例复发,复发率为2.7例/100例月,平均复发间隔为36.7月。复发肿瘤无分级增高,但2例分期增高至T_2期。
TUR is the preferred treatment for superficial bladder tumors, but the recurrence rate is as high as 50 to 70% within 2 to 5 years, and 20% of recurrences will have tumor grade and/or stage increase. Patients with carcinoma in situ have a higher recurrence rate. In recent years, preventive intraluminal chemotherapy has been used to prevent tumor recurrence. Mitomycin C (MMC) is one of the most effective drugs, but the dose, time, and frequency of administration are not uniform. The authors used a randomized prospective trial to evaluate the effect of half an hour and one hour of infusion of MMC on relapse rate, recurrence interval, and tumor progression. METHODS AND RESULTS After 2 weeks of TUR, MMC was initiated by intravesical instillation of 40 mg/40 ml NS once a week for 8 consecutive times and once every month for 4 consecutive times. Of the 70 patients treated, 14 were withdrawn due to severe toxicity and the remaining 56 patients were divided into 2 groups. In the half-hour group, 28 patients were followed up for 15.7 months and 10 patients relapsed. The recurrence rate was 2.7 cases/100 months, and the average recurrence interval was 36.7 months. There was no increase in grades of recurrent tumors, but 2 cases increased to T2 stage.