膀胱部分切除术中使用羟基喜树碱预防肿瘤切口种植复发疗效观察

Prevention of Tumor Seeding and Wound Recurrence with Hydroxycamptothecin in Partial Cystectomy

目的:探讨膀胱尿路上皮细胞癌行膀胱部分切除术中使用羟基喜树碱浸泡切口,以预防肿瘤切口种植复发的临床效果。方法:回顾性分析396例接受膀胱部分切除术患者的临床资料:所有患者均经病理检查诊断为尿路上皮细胞癌.其中男220例,女176例.中位年龄64岁。肿瘤病理分期为T_1期27例,T_2期163例,T_3期144例.T_1期62例。手术整块切除肿瘤及其周边膀胱壁组织后,用羟基喜树碱40 mg溶于生理盐水40 ml中.浸泡膀胱腔、膀胱前壁切口、耻骨后间隙及手术切口共5min.吸出药液后用约500 ml蒸馏水或生理盐水冲洗2～3次。结果:本组围手术期主要并发症包括严重的尿路刺激症27例(6.8%),伤口感染或延期愈合12例(3.0%).尿瘘9例(2.3%).上尿路感染8例(2.0%),术后出血3例(0.8%)。377例患者获得随访,中位随访时间61个月(8～117个月),仅1例患者肿瘤切口种植复发,发生率为0.27%。结论:膀胱尿路上皮细胞癌患者行膀胱部分切除术中使用羟基喜树碱浸泡手术切口.能显著降低肿瘤切口种植复发的发生率.方法简单、有效、安全。

Objective： To study the effects of prevention of tumor seeding and wound recurrence with 10-hydroxycamptothecin irrigation in partial cystectomy for urothelial tumor of bladder. Methods： We retrospectively reviewed clinical data of 396 patients with urothelial tumor of bladder treated with partial cystectomy. All patients were diagnosed pathologically. Two hundred twenty men and 176 women were identified with a median age of 64 years. Twenty-seven patients had pathological stage of T： , 163 had Te, 144 had T3 and 62 had T4. The gross tumor was resected included a rim of surrounding of the bladder wall. Then 40rag 10-hydroxycamptothecin dissolve in 40ml normal saline was utilized to irrigate bladder, retropubic space and incision for 5 minutes. Irrigation with 500 ml normal saline or distilled water two or three times was performed after exsuction of 10-hydroxycamptothecin solution. Results：The main complications in perioperative period of our series included 27cases （6.8 %） of significant irritative symptoms, 12 cases （3.0%） of wound infection or prolonged healing, 9 cases （2.3 % ） of vesicocutaneous fistula, 8 cases （2.0%） of upper urinary tract infection and 3 cases （0.8 % ） of hemorrhage. Three hundred and seventy-seven patients were followed up. The mean follow-up was 61 months （8 to 117 months）. Only one patient （0.27 %） had wound tumor seeding and recurrence. Conclusions：Irrigation of wound with 10-hydroxycamptothecin in partial cystectomy of urothelial tumor of bladder could significantly diminish tumor seeding and minimize wound recurrence. It offers a simple, effective and safe measure.