术中粘膜下注射白细胞介素-2及术后灌注吡柔比星预防浅表性膀胱癌术后复发(附206例临床分析)

Prevention of Superficial Bladder Cancer Recurrence by Intraoperative Submucosal Injection of Interleukin-2 and Postoperative Intravesical Instillation of Pirarubicin (206 Cases Report)

目的评价术中粘膜下注射白细胞介素-2配合术后膀胱内灌注吡柔比星预防浅表性膀胱癌术后复发的有效性及安全性。方法206例浅表性膀胱癌患者,36例行经尿道膀胱肿瘤电切术,170例行膀胱部分切除术,均于术中粘膜下注射白细胞介素-2 100万IU,于手术后2周开始行吡柔比星膀胱灌注,每次30 mg,每周1次共12次,以后每2周1次共6次,以后每月1次共6次,第二年重复,第三年每月一次。定期膀胱镜检查随访。结果粘膜下注射后,发热79例,全身关节痛及不适57例;膀胱灌注后42例出现尿路刺激症状,经对症处理后缓解。术后平均随访60个月,肿瘤复发35例(17.0%)。结论术中粘膜下注射白细胞介素-2术后配合膀胱内灌注吡柔比星预防膀胱癌术后复发效果明确,疗效满意,患者耐受性好,是较为理想的治疗方法。

Objective To assess the efficacy and safety of intraoperative submucosal injection of interleukin-2（IL-2） and postoperative intravesical instillation of pirarubicin for prevention of superficial bladder cancer recurrence.Methods 206 superficial bladder cancer cases were underwent operation,including 36 of transurethral resection of bladder tumor（TURBt） and 170 of bladder partial cystectomy.The therapy above mentioned was performed to prevent tumor recurrence in all the patients.The dosage of IL-2 injection was 10×106 IU.The piarubicin of 30 mg per time was instilled intravesically within 2 weeks after operation once a week for 12 weeks,followed by once two weeks for 6 times,and then once a month for 6 times.The schedule was repeated in the 2nd year and the frequency was once a month in the 3rd year.Regular cystoscopy was performed for the follow-up.Results There were 79 of fever and 57 of arthrodynia and general malaise after submucosal injection,and 42 of urine irritative symptoms after intravesical instillation,and the complications were relieved by expectant treatment.Within 60 months follow-up averagely,tumor recurrence was found in 35 cases（17.0%）.Conclusion Intraoperative submucosal injection of interleukin-2（IL-2） and postoperative intravesical instillation of pirarubicin is an effective and well-tolerated therapy for prevention of superficial bladder cancer recurrence.