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目的目前肌层浸润性膀胱癌的发病率呈上升趋势,根治性膀胱切除术创伤大、出血多、术后生活质量差,部分患者拒绝或不愿行根治性膀胱切除术。本研究探讨应用根治性经尿道等离子电切术(radical of transurethral resection of bladder tumor,RTURBT)联合膀胱灌注化疗及全身化疗治疗肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)的疗效和安全性。方法回顾性分析章丘市中医医院2009-01-01-2014-01-01收治的24例MIBC患者的临床资料。24例患者均在全麻或腰硬联合麻醉下行RTURBT术。辅助治疗于术后2周开始,给予吡柔比星30 mg膀胱灌注(1次/周,共8次,随后1次/月,共1年)及吉西他滨1 000 mg/m~2(d_1、d_8、d_(15),静脉滴入)联合顺铂70 mg/m~2(d_2,静脉滴入)静脉化疗,4周为1个周期,共4个周期。结果 24例患者均顺利完成手术,术中平均出血80.3 mL(50~180 mL),术中及术后无严重并发症。术后病理,低级别浸润性尿路上皮癌10例,高级别浸润性尿路上皮癌14例,肿瘤侵犯浅肌层13例,侵犯深肌层11例,基底部均未查见癌。膀胱灌注化疗及全身化疗耐受良好,不良反应多为胃肠道反应(22例)、骨髓抑制(19例)和尿路刺激症状(17例),对症处理后,所有患者均完成治疗。治疗后24例患者均获随访,术后随访12~60个月,平均30个月。复发7例(29.2%),首次复发中位时间为术后10.5个月(5.0~26.0个月)。3例(12.5%)患者死亡,2例(8.3%)死于远处转移,1例死于脑血管疾病。结论行RTURBT联合化疗治疗MIBC的创伤小、出血少、安全性高,是MIBC患者可以选择的治疗方法。
Objective Currently, the incidence of myometrial invasive bladder cancer is on the rise. Radical cystectomy has a large trauma, more bleeding and poor quality of life. Some patients refuse or are not willing to undergo radical cystectomy. This study was to evaluate the efficacy and safety of radical urethral resection of bladder tumor (RTURBT) in combination with intravesical instillation chemotherapy and systemic chemotherapy in the treatment of muscle invasive bladder cancer (MIBC) . Methods The clinical data of 24 MIBC patients admitted to Zhangqiu Hospital of Traditional Chinese Medicine from January 2009 to January 2016 were analyzed retrospectively. Twenty-four patients underwent RTURBT under general anesthesia or combined spinal-epidural anesthesia. Adjuvant therapy started at 2 weeks postoperatively with intraperitoneal injection of pirarubicin 30 mg intravesically (1 time / week for 8 times, followed by 1 time / month for 1 year) and gemcitabine 1 000 mg / m 2 (d 1, d_8, d_ (15), intravenous infusion) combined with cisplatin 70 mg / m ~ 2 (d_2, intravenous) intravenous chemotherapy, 4 weeks for a cycle, a total of 4 cycles. Results All the 24 patients completed the operation successfully. The mean bleeding volume was 80.3 mL (50-180 mL) during operation. No serious complications occurred during and after operation. Postoperative pathology, low grade invasive urothelial carcinoma in 10 cases, high grade invasive urothelial carcinoma in 14 cases, tumor invasion in 13 cases of superficial myometrial invasion of deep muscle in 11 cases, basal ganglia were not found in cancer. Bladder chemotherapy and systemic chemotherapy were well tolerated. Adverse reactions were mostly gastrointestinal reactions (22 cases), myelosuppression (19 cases) and urinary tract irritation symptoms (17 cases). All patients were treated after symptomatic treatment. After treatment, 24 patients were followed up, followed up for 12 to 60 months, an average of 30 months. Recurrent in 7 cases (29.2%), the median time to first recurrence 10.5 months after surgery (5.0 ~ 26.0 months). Three patients (12.5%) died, two (8.3%) died of distant metastases and one died of cerebrovascular disease. Conclusions The treatment of MIBC with RTURBT combined with chemotherapy is less invasive, less bleeding and more safe. It is an alternative treatment for MIBC patients.