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目的:结合文献探讨保留膀胱的局部切除联合髂内动脉插管化疗治疗浸润性膀胱癌的可行性和有效性。方法:对33例不能或不愿接受膀胱全切手术的T_2～T_4浸润性膀胱癌患者,18例术前给予新辅助介入化疗1～3个疗程后给予局部切除,15例在经尿道切除术后,给予辅助介入化疗3次。化疗方案为顺铂80 mg、表柔吡星50 mg以及5氟尿嘧啶1 g(或羟基喜树碱40 mg)。结果:术前新辅助化疗组肿瘤均有不同程度的缩小,完全恢复1例,部分恢复16例,无效1例,平均随访31.6月,1例术后因肿瘤转移死亡,局部复发7例,远处转移2例;术后辅助化疗组,平均随访27个月,术后复发5例,远处转移1例,无死亡病例。结论:联合应用髂内动脉插管化疗结合保留膀胱的局部切除,是治疗浸润性膀胱肿瘤的可选择有效手段,术前确诊的浸润性肿瘤,应选择新辅助介入化疗。
OBJECTIVE: To investigate the feasibility and effectiveness of local excision combined with internal iliac artery catheterization in the treatment of invasive bladder cancer. Methods: Thirty-three patients with T 2 T 4 invasive bladder cancer who were unable or unwilling to undergo total bladder resection were treated with local excision of 18 patients undergoing neoadjuvant interventional chemotherapy 1 to 3 courses of treatment and 15 underwent transurethral resection After giving auxiliary intervention chemotherapy 3 times. Chemotherapy regimens were cisplatin 80 mg, epirubicin 50 mg, and 5 fluorouracil 1 g (or hydroxycamptothecine 40 mg). Results: Neoadjuvant chemotherapy group had different degrees of tumor shrinkage in total extent, complete recovery in 1 case, partial recovery in 16 cases, ineffectiveness in 1 case, average follow-up in 31.6 months, 1 case died of tumor metastasis and 7 cases local recurrence 2 cases were transferred. In the postoperative adjuvant chemotherapy group, the patients were followed up for an average of 27 months. Five patients relapsed and one patient had distant metastasis. There were no deaths. Conclusion: The combined use of internal iliac artery catheterization chemotherapy with local excision of the retained bladder is an effective and effective method for the treatment of invasive bladder cancer. Preoperative diagnosis of invasive tumors should be selected neoadjuvant interventional chemotherapy.