浸润性膀胱癌术前选择性髂内动脉灌注化疗的近远期疗效观察

Preoperative selective internal iliac arterial chemotherapy for invasive bladder cancer

目的 观察选择性髂内动脉灌注化疗联合手术治疗浸润性膀胱癌的近远期效果。 方法 通过双侧股动脉插管对 5 6例浸润性膀胱癌患者进行选择性髂内动脉灌注化疗 (顺铂加阿霉素 ) ,2次化疗间隔 3～ 4周。化疗 2周后复查膀胱镜和B超。化疗后根据临床分期采用保留膀胱或膀胱全切手术。 结果 动脉化疗后肿瘤体积缩小和临床分期降低 4 2例 ,肿瘤体积和分期不变或增加 14例。化疗后 5 6例患者根据肿瘤大小和临床分期行经尿道膀胱肿瘤切除 2 1例 ,膀胱部分切除术 5例 ,根治性膀胱全切术 2 8例 ,2例分别行单纯回肠膀胱术和输尿管皮肤造口术。随访 4 0例肿瘤切除患者 ,1、2、3、5年无瘤生存率分别为 85 .0 % ,70 .0 % ,5 7.5 %和 5 0 .0 %。 结论 术前动脉化疗可使多数浸润性膀胱癌降期 ,使部分患者接受保留膀胱手术 ,部分高分期 (T4)患者接受根治性膀胱切除术 。

Objective To evaluate the short term and long term clinical effect of internal iliac arterial chemotherapy (IIAC) followed by surgery for invasive bladder cancer. Methods Fifty six patients with invasive bladder cancer were preoperatively treated by IIAC with cisplatin (100 mg/m 2) and adriamycin (30 mg/m 2).All the cases received IIAC twice with 3 to 4 weeks interval.Two weeks after the second chemotherapy,the patients were examined by ultrasound and cystoscopy.Bladder preserving operation or radical cystectomy was performed according to clinical stages and grades of the bladder cancer. Results Two weeks after IIAC,down staging was observed in 42 patients (75%),and no change or increase in volume and stage were observed in 14 patients (25%).After IIAC TURBt was performed on 21 patients,partial cystectomy on 5,and radical cystectomy on 28 depending on the rumor size and clinical stages.The 1 ,2 ,3 ,5 year disease free survival rate in evaluative 40 patients was 85.0%,70.0%,57.5%,50.0%,respectively. Conclusions IIAC as a neoadjuvant chemotherapy has the possibility of down staging the cancer,which provides the chance of bladder preserving operations for invasive bladder cancer, and the possibility of radical cystectomy for high stage (T 3b ～T 4) bladder cancer.IIAC followed by surgery can effectively improve the disease free survival rate for invasive bladder cancer.