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目的探讨经尿道膀胱肿瘤电切术后单次髂内动脉栓塞化疗对难治性膀胱癌的疗效。方法1999年11月~2005年6月,对12例难治性膀胱癌应用经尿道膀胱肿瘤电切(transurethralresectionofbladdertumor,TURBt)术后加用髂内动脉栓塞化疗。先经尿道将膀胱肿瘤完整切除,术后1周行双侧髂内动脉造影,采用Seldinger技术,经右侧股动脉插管,明确正常血供与肿瘤血管,然后向双侧髂内动脉各注入半量化疗药物(表阿霉素各25mg),再超选择至膀胱肿瘤血管注入末梢栓塞剂(即化疗栓塞剂,为明胶海绵碎块与顺铂200mg之混合物),可反复栓塞,直至所有肿瘤血管化疗栓塞满意为止。术后常规用表阿霉素膀胱灌注,每3个月复查膀胱镜。结果动脉栓塞化疗后,12例均有恶心、食欲不振,呕吐3例,发热2例,经对症处理缓解。臀部轻度疼痛6例,3~5日缓解。血红细胞、白细胞减少4例,对症处理2周后正常。肝肾功能无明显变化。随访4~55个月,平均34个月。1例术后12个月复发,其余11例无瘤生存。结论此种方法治疗难治性膀胱癌的复发率低、副作用小,为不愿行膀胱全切的患者提供了一种新的选择。
Objective To investigate the curative effect of single internal iliac artery embolization chemotherapy on refractory bladder cancer after transurethral resection of bladder tumor. Methods From November 1999 to June 2005, 12 cases of intractable bladder cancer were treated by transurethral resection of bullous tumor (TURBt) plus internal iliac artery embolization. The first complete removal of the bladder tumor through the urethra, after 1 week of bilateral iliac artery angiography, the use of Seldinger technology, the right femoral artery catheterization, clear the normal blood supply and tumor blood vessels, and then to the bilateral internal iliac artery injection of semi-dose of chemotherapy drugs (Epirubicin each 25mg), and then select to the end of the bladder tumor vascular embolization (ie chemotherapy embolic agent, a mixture of gelatin sponge fragments and cisplatin 200mg), repeated embolization until all tumor vascular chemoembolization satisfied until. Postoperative routine epirubicin bladder perfusion, cystoscopy every 3 months review. Results After arterial embolization and chemotherapy, nausea, loss of appetite and vomiting were found in all 12 patients, with fever in 2 and symptomatic treatment. Hip mild pain in 6 cases, 3 to 5 days to ease. 4 cases of red blood cells, leukopenia, symptomatic treatment after 2 weeks normal. No significant changes in liver and kidney function. Follow-up 4 to 55 months, an average of 34 months. One patient recurred 12 months after operation, and the remaining 11 patients survived without any tumor. Conclusions This method has a low recurrence rate and small side effects in the treatment of refractory bladder cancer. It provides a new option for patients who are unwilling to perform total cystectomy.