二次电切联合卡介苗膀胱灌注治疗高级别非肌层浸润性膀胱癌的疗效分析

doi:10.19558/j.cnki.10-1020/r.2020.05.010

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摘要 目的：探讨二次电切联合卡介苗膀胱灌注治疗高级别非肌层浸润性膀胱癌（NMIBC）的疗效及安全性。方法：回顾性对照研究2015年2月–2019年2月手术治疗的67例NMIBC患者临床资料。依据收治时间段分为两组,2015年2月–2016年4月的患者采用单次电切治疗归为A组,共24例,该组患者于电切术后2周开始卡介苗膀胱灌注治疗;2016年5月–2019年2月的患者采用二次电切治疗归为B组,共43例,该组患者首次电切术后3周行第二次电切术,第二次电切术后2周开始卡介苗膀胱灌注治疗。卡介苗膀胱灌注治疗方案为：卡介苗120 mg/次,1次/周×6周+1次/2周×6周+1次/月×10个月。分析两组患者术后2年内的肿瘤复发率、进展率、中位无复发生存期,观察卡介苗膀胱灌注的不良反应情况。结果：A组中肿瘤复发率为37.50%,复发患者的中位无复发生存时间为11.40个月（6~18个月）,3例进展为肌层浸润性膀胱癌,1例合并盆腔及腹膜后淋巴结转移,肿瘤进展率为12.50%;B组中肿瘤复发率为16.30%,复发患者的中位无复发生存时间为16.51个月（9~24个月）,2例进展为肌层浸润性膀胱癌,1例盆腔淋巴结转移,肿瘤进展为6.98%,两组间2年无复发生存率、肿瘤进展率、中位无复发生存时间比较均差异有统计学意义（P<0.05）。67位患者中有47例出现不同程度的尿频、尿急、尿痛等膀胱刺激症状,其中肉眼血尿患者3例（A组1例,B组2例）,并发膀胱炎患者5例（A组2例,B组3例）,继发发热患者1例（B组）,两组比较差异无统计学意义（P>0.05）。结论：采用二次电切联合卡介苗膀胱灌注治疗高级别NMIBC患者可减少术后肿瘤残留、降低肿瘤复发率、肿瘤进展率,明显延长中位无肿瘤生存期,无严重不良反应。

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	曹勇
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关键词 ：非肌层浸润性膀胱癌, 二次电切, 卡介苗, 复发, 进展

Abstract：Objective： To investigate the efficacy and safety of second transurethral resection combined with BCG intravesical therapy in the treatment of high-grade non-muscle invasive bladder cancer （NMIBC）. Methods： The clinical data of 67 patients with NMIBC treated surgically from February 2015 to February 2019 were analyzed retrospectively. A total of 24 patients were enrolled in group A （single TURBT）： combined BCG instillation after single TURBT. A total of 43 patients were enrolled in group B （second transurethral resection）： combined BCG instillation after the second electrotomy. The 120 mg BCG was dissolved into 50 mL saline for instillation and kept for 2 h. The following induction scheme was done： BCG 120 mg/time, once every week for 6 weeks; once every two weeks for 6 weeks; once every month for 10 months. The recurrence rate, progression rate, median recurrence-free survival and adverse reactions of BCG in the two groups were analyzed within 2 years after surgery. Results： In group A, the tumor recurrence rate was 37.50%, the progression rate was 12.50%, and the median RFS was 11.4 （6-18） months. In group B, the tumor recurrence rate was 16.30%, the progression rate was 6.98%, and the median RFS was 16.51 （9-24） months. There was statistically significant difference （all P < 0.05）. The incidence rate of adverse effects was 70.14%, and severe symptoms occurred in 9 patients. Conclusions： For high-grade NMIBC patients, second transurethral resection combined with BCG instillation can reduce postoperative residual tumor, postpone postoperative recurrence and progression, prolong the median RFS, and improve prognosis of the patients.

Key words： non-muscle invasive bladder cancer second transurethral resection bacillus calmette guerin recurrence progression

收稿日期: 2020-03-09

ZTFLH:

R694

通讯作者: 曹勇,caoyongrz@126.com

引用本文:

曹勇, 厉进雪, 王文峰, 厉波, 杨玉苗, 吴利兵. 二次电切联合卡介苗膀胱灌注治疗高级别非肌层浸润性膀胱癌的疗效分析[J]. 微创泌尿外科杂志, 2020, 9(5): 337-341.
CAO Yong, LI Jinxue, WANG Wenfeng, LI Bo, YANG Yumiao, WU Libing. Efficacy of second transurethral resection combined with BCG instillation in the treatment of high-grade non-muscle invasive bladder cancer. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(5): 337-341.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1624.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2020/V9/I5/337

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