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目的:探讨光动力治疗(PDT)在预防非浸润性膀胱癌TURBT术后复发和进展中所起的作用,并比较两代光敏剂之间作用的差异。方法:选取2005年6月～2011年4月确诊为非浸润性膀胱癌患者138例为试验组。其中A组47例采用血卟啉为光敏剂;B组91例采用5-盐酸氨基酮戊酸为光敏剂。另选106例常规治疗患者为对照组。所有患者于TURBT术后24小时内行灌注治疗,试验组于术后1周内行PDT。其中A组在光敏剂给药(5mg/kg)36、60小时后行两次PDT,于初次给药72小时后再次静脉滴注光敏剂100mg,待12小时后行第三次PDT,每次20min;B组则在光敏剂给药2小时后行PDT一次,时间60min。两组均以波长630nm激光,能量功率约为50mW/cm2进行全膀胱内照射。出院后,患者均给予常规为期1年的膀胱灌注治疗。A组、B组及对照组平均随访21、23和18个月。结果:试验组肿瘤总体复发率为33.3%(46/138),A、B组复发率分别为31.9%(15/47)和34.1%(31/91)。试验组中发展为浸润性膀胱癌的进展率为10.9%(15/138),A、B组分别为10.6%(5/47)、11.0%(10/91)。对照组肿瘤复发率和进展率分别为49.1%(52/106)和24.5%(26/106)。经卡方检验,A、B组及试验组和对照组肿瘤复发率和进展率之间比较,差异均有统计学意义(P<0.05);A组与B组比较,差异均无统计学意义(P>0.05)。结论:在传统治疗方法的基础上加用PDT,对降低非浸润性膀胱癌的复发率和进展率有积极作用。但两代光敏剂在非浸润性膀胱癌的治疗效果上无明显差异。
Objective: To investigate the role of photodynamic therapy (PDT) in preventing recurrence and progression of non-invasive bladder cancer after TURBT and to compare the differences between the two photosensitizers. Methods: 138 cases of non-invasive bladder cancer diagnosed from June 2005 to April 2011 were selected as the experimental group. Among them, 47 cases in group A were treated with hematoporphyrin as photosensitizer; 91 cases in group B were treated with 5-aminolevulinic acid as photosensitizer. Another 106 routine treatment patients for the control group. All patients underwent perfusion within 24 hours after TURBT. The experimental group underwent PDT within 1 week after operation. Group A received photosensitizer (5mg / kg) for 36 and 60 hours, PDT twice, intravenous infusion of photosensitizer 100mg 72 hours after initial administration, and the third PDT after 12 hours 20min; Group B in the photosensitizer administered PDT once 2 hours after the time 60min. The two groups were all with the wavelength of 630nm laser, the power of about 50mW / cm2 total intravesical irradiation. After discharge, patients were given routine 1-year bladder irrigation. Groups A, B and control groups were followed up for an average of 21, 23 and 18 months. Results: The overall recurrence rate was 33.3% (46/138) in the experimental group and 31.9% (15/47) and 34.1% (31/91) in the A and B groups, respectively. The progress rate of invasive bladder cancer was 10.9% (15/138) in the experimental group and 10.6% (5/47) and 11.0% (10/91) in the A and B groups, respectively. The tumor recurrence rate and progression rate in control group were 49.1% (52/106) and 24.5% (26/106), respectively. The chi-square test, A, B group and the test group and control group tumor recurrence rate and the rate of progress between the differences were statistically significant (P <0.05); A group and B group, the difference was not statistically significant (P> 0.05). Conclusion: The addition of PDT to traditional treatments has a positive effect on reducing the recurrence rate and progression rate of non-invasive bladder cancer. However, two generations of photosensitizers in non-invasive bladder cancer treatment effect no significant difference.