经尿道电切加吡柔比星膀胱灌注治疗浅表性膀胱肿瘤(附40例诊治体会)

TURBT PLUS INTRAVESICAL INSTILLATION OF PIRARUBICIN(THP) FOR SUPERFICIAL BLADDER TUMOR IN 40 PATIENTS

目的：总结经尿道电切加吡柔比星膀胱灌注治疗浅表性膀胱肿瘤的疗效。方法：采用经尿道膀胱肿瘤电切，联合术后吡柔比星膀胱灌注治疗浅表性膀胱肿瘤40例，男25例，女15例，平均年龄55岁，肿瘤单发30例，多发10例，病理分级G1～G2，分期T1-T2，肿瘤直径0．5-4cm。结果：手术均一次成功，手术时间平均20min，术中平均出血量〈20ml，无膀胱穿孔或术后继发性出血等严重并发症。术后创面基底及创缘病理检查无残余肿瘤，术后均行吡柔比星1年短期膀胱灌注化疗。40例随访3-20个月，平均9．5个月。术后1年复发率5％（2／40），2年7．5％（3／40），3年15％（6／40）。膀胱灌注副反应发生率为17.5％。结论：经尿道电切加吡柔比星膀胱灌注是治疗浅表性膀胱肿瘤的一种理想方法。

Objective：To evaluate the effectiveness and safety of transurethral resection of bladder tumor （TURBt） combined with intravesical instillation of pirarubicin in the treatment of superficial bladder tumors. Methods：40 patients with superficial bladder tumors were treated by endoscopic TURBt with postoprative intrav- esical instillation of pirarubicin. There were 25 male and 15 female patients with an average age of 55. The growth was single in 30 and multiple in 10 patients. The diameter of the tumor was 0.5-4cm with the pathology grade G1～G2 and clinical stage T1-T2. Results：The procedure finished successfully in all patients and cold cup biopsies of the tumor base and incisal margin were negative. The mean resection time was 20 minutes. The mean volume of bleeding was less than 20 ml and no intraoperative bladder perforation or secondary hemorrhage oc- curred. All patients were followed up for 3 to 20 months with a mean of 9.5 months.The recurrence rates at the lst,2nd and 3rd year were 5%（2/40）,7.5%（3/40） and 15%（6/40） respectively. The side effect rate was 17.5%. Conclusion： TURBt combined with intravesical chemotherapy of pirarubicin in the treatment of superficial bladder tumors provides an useful clinical therapy.