膀胱肿瘤剥切术毕即刻灌注吡柔比星治疗非肌层浸润性膀胱癌疗效观察

doi:10.19558/j.cnki.10-1020/r.2019.05.013

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摘要 目的：评价经尿道膀胱肿瘤剥切术（TUSDBT）术毕即刻灌注吡柔比星(THP)治疗非肌层浸润性膀胱癌（NMIBC）的临床疗效。方法：从清华大学第一附属医院泌尿外科建立的膀胱癌云数据库中,严格按入组标准导出2009年1月1日–2016年12月31日接受TUSDBT+术毕即刻灌注+维持灌注治疗的NMIBC患者82例,将临床资料去隐私化后,导入SPSSAU进行线上统计分析。结果：随访时间为24.2~107.5个月,2年内未出现死亡病例,也无患者因膀胱灌注化疗的副作用停止灌注。入组患者在3、6、12、18、24个月内的复发情况分别为0例、4例（4.9%）、7例（8.5%）、8例（9.8%）、10例（12.2%）,总复发率为24.4%,平均无瘤生存期为（25.69±20.67）个月,中位无瘤生存期为25.1个月。患者的性别、年龄、肉眼血尿、尿脱落细胞学阳性、肿瘤直径、肿瘤数目、病理分期、组织学分级、危险分组对2年复发率的影响均差异无统计学意义（P>0.05）,但肿瘤数目与尿脱落细胞阳性对总复发率的影响差异有统计学意义（P<0.05）。结论：对于经严格筛选的NMIBC患者,若TUSDBT中未发生膀胱穿孔等严重并发症,均应于手术室中即刻灌注,并辅以14次THP维持灌注治疗,可有效防止膀胱肿瘤复发,值得临床推广。

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	武昊
	王文佳
	吴建臣
	王帅军
	季浩宇
	韩菲
	李胜文

关键词 ：非肌层浸润性膀胱癌, 膀胱灌注, 吡柔比星, 术毕即刻灌注, 复发

Abstract：Objective： To evaluate the clinical efficacy of transurethral submucosal dissection of bladder tumor (TUSDBT) combined with immediate postoperativepirarubicin instillation in the treatment of non-muscle invasive bladder cancer (NMIBC). Method： 82 cases of NMIBC patients from January 1, 2009 to December 31, 2016 were exported from the Bladder Cancer Cloud Database established by our department according to the strict inclusion criteria.All of them had received a TUSDBT and an immediate and maintenance intravesical instillation of THP in our hospital. After the clinical data had got rid of privacy, SPSSAU was used for online statistical analysis. Results： The follow-up time was 24.2 to 107.5 months. Within 2 years, no patients died and no one stopped instillation due to the side effects of intravesical instillation therapy. The 3, 6, 12, 18 and 24 months recurrence rates were 0, 4.9%, 8.5%, 9.8% and 12.2%, respectively. The total recurrence rate was 24.4%, the average tumor-free survival time was 25.69±20.67 months, and the median tumor-free survival time was 25.1 months. In this study, gender, age, gross hematuria, urinary exfoliative cytology positive, tumor diameter, tumor number, pathological stage, histological grade, risk group had no statistically significant effect on 2-year recurrence rate (P>0.05). However, the effect of tumor number and urine exfoliated cells on total recurrence rate was statistically significant (P<0.05). Conclusion： If the strict selected NMIBC patients do not have serious complications, such as bladder perforation in TUSDBT, an immediate intravesical instillation should be considered instillation in the operation room, supplemented with THP maintenance instillation for 14 times,which can be effective in the prophylaxis of tumor recurrence and deserve the clinical expansion.

Key words： non-muscle invasive bladder cancer intravesical instillation Pirarubicin immediatepostoprative intravesical instillation recurrence

收稿日期: 2019-01-21

ZTFLH:

R737.14

通讯作者: 李胜文,swli@tsinghua.edu.cn

引用本文:

武昊, 王文佳, 吴建臣, 王帅军, 季浩宇, 韩菲, 李胜文. 膀胱肿瘤剥切术毕即刻灌注吡柔比星治疗非肌层浸润性膀胱癌疗效观察[J]. 微创泌尿外科杂志, 2019, 8(5): 350-354.
WU Hao, WANG Wenjia, WU Jianchen, WANG Shuaijun, JI Haoyu, HAN Fei, LI Shengwen. Observation of curative effect of TUSDBT combined with immediate postoperative THP intravesical instillation on NMIBC. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(5): 350-354.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1540.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2019/V8/I5/350

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