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目的探讨经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)联合膀胱灌注化疗及静脉化疗治疗浸润性膀胱癌的临床疗效。方法影像及病理均明确诊断为浸润性膀胱癌不能耐受或拒绝行根治性膀胱切除术患者20例,肿瘤直径1.8~5.0cm,病理分级G211例,G39例,TNM分期T2a9例,T2b10例,T4a1例。采用TURBT切除肿瘤至膀胱壁外脂肪层,其中1例肿瘤侵犯前列腺者同时行经尿道前列腺电切术,切除范围至肿瘤基底部周围2cm正常膀胱黏膜。术后GC方案(吉西他滨+顺铂)静脉化疗,每三周为1个周期;吡柔比星膀胱灌注化疗,每周一次。每三个月复查膀胱镜评估肿瘤复发情况。结果 20例患者手术顺利,手术时间35~100min,围手术期未见严重并发症。术后病理报告均为浸润性尿路上皮癌。化疗后出现白细胞下降4例,恶心、食欲减退等胃肠道反应6例,对症处理后均好转。术后随访3~24个月,平均12个月。术后6个月复发1例,术后12个月复发1例,术后24个月复发1例。复发病例中T4a1例,T2b2例。术后6个月复发者死于肿瘤远处转移。结论 TURBT联合化疗治疗浸润性膀胱癌有一定疗效,可作为保留膀胱的一种综合治疗方法。
Objective To investigate the clinical efficacy of transurethral resection of bladder tumor (TURBT) combined with intravesical instillation chemotherapy and intravenous chemotherapy in the treatment of invasive bladder cancer. Methods Twenty patients with invasive bladder cancer who could not tolerate or reject radical cystectomy were diagnosed by imaging and pathology. The tumor diameter was 1.8-5.0cm. The pathological grade G211, G39, TNM stage T2a9, T2b10, T4a1 cases. TURBT excision of the tumor to the outer wall of the bladder fat layer, of which 1 case of tumor invasion of the prostate at the same time by transurethral resection of the prostate resection range to 2cm around the tumor base of the normal bladder mucosa. Postoperative GC regimen (gemcitabine + cisplatin) intravenous chemotherapy, every three weeks for a cycle; pirarubicin bladder irrigation chemotherapy once a week. Cystoscopy was reviewed every three months for tumor recurrence. Results Twenty patients underwent surgery successfully. The operation time ranged from 35 to 100 minutes. There were no serious complications during perioperative period. Postoperative pathological reports were invasive urothelial carcinoma. Chemotherapy after leukopenia in 4 cases, nausea, loss of appetite and other gastrointestinal reactions in 6 cases, symptomatic treatment were improved. The patients were followed up for 3-24 months with an average of 12 months. One patient recurred 6 months after operation, one patient recurred 12 months after operation, and one patient recurred 24 months after operation. T4a1 cases of recurrent cases, T2b2 cases. 6 months after recurrence died of tumor distant metastasis. Conclusion TURBT combined with chemotherapy in the treatment of invasive bladder cancer has a certain curative effect, which can be used as a comprehensive treatment of bladder retention.