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目的总结保留膀胱手术加膀胱内灌注羟基喜树碱疗法治疗膀胱移行细胞癌的疗效和经验。方法对接受保留膀胱手术并辅助膀胱内灌注羟基喜树碱治疗的65例膀胱移行细胞癌患者进行回顾性分析。膀胱部分切除术22例,经尿道膀胱肿瘤电切术(TURBT)41例,经尿道膀胱肿瘤激光治疗(TULBT)2例。术后给予羟基喜树碱40mg加生理盐水40mL膀胱灌注;定期复查膀胱镜,术后每半年作复查血尿及生化常规、胸片、腹部B超及泌尿系CT等。结果平均随访时间36.5个月(6～96个月),22例复发,复发间隔18个月;8例进展,进展间隔16.8个月;61例无瘤生存,4例死于膀胱癌,除外1例术后8个月死亡,其余患者均为术后42个月及以上死亡。结论保留膀胱手术加膀胱内灌注羟基喜树碱疗法治疗膀胱癌,在肿瘤复发及进展上均有一定的抑制作用,可改善患者的存活时间,但对于深肌层浸润的膀胱癌患者应尽早行膀胱全切术。
Objective To summarize the curative effect and experience of reserving bladder surgery plus intravesical instillation of hydroxy camptothecin for bladder transitional cell carcinoma. Methods A retrospective analysis was performed on 65 patients with bladder transitional cell carcinoma who underwent preserved bladder surgery and assisted intravesical instillation of hydroxycamptothecin. Partial bladder resection in 22 cases, transurethral resection of the bladder tumor (TURBT) 41 cases, transurethral bladder tumor laser treatment (TULBT) in 2 cases. Postoperative intramuscular injection of 40mg hydroxycamptothecine plus normal saline 40mL; regular review of cystoscopy, postoperative every six months for review of hematuria and biochemical routine, chest X-ray, abdominal ultrasound and urinary tract CT. Results The average follow-up time was 36.5 months (range, 6 to 96 months). Twenty-two patients relapsed with a recurrence interval of 18 months. Eight patients progressed with a progression of 16.8 months. Sixty-one patients survived without tumor and four patients died of bladder cancer except 1 Cases died 8 months after surgery, the remaining patients were 42 months and above deaths. CONCLUSION: Bladder surgery plus intravesical instillation of hydroxycamptothecin for the treatment of bladder cancer has a certain inhibitory effect on tumor recurrence and progression, which can improve the survival time of patients, but patients with deep myometrial invasion of bladder cancer should be as soon as possible Total hysterectomy.