浅表性膀胱肿瘤术后卡介苗、丝裂霉素、吡柔吡星膀胱灌注疗效及副作用的临床观察

The Clinical Investigation for the Efficacy and Safety of Intravesical Instillation of BCG,MMC and THP after TUR-Bt

目的探讨丝裂霉素（MMC）、卡介苗（BCG）和吡柔吡星（THP）膀胱内灌注预防浅表性膀胱肿瘤术后复发的有效性及安全性。方法回顾性分析我院1997年1月1日至2006年3月1日采用三种方式治疗的浅表性膀胱肿瘤225例资料，其中采用BEG 53例、MMC 103例和THP 69例。每组按既定方案膀胱灌注治疗，总疗程2年，术后平均随访时间（11．8±6．93）个月。结果三种治疗的复发率分别为MMC 58．25％、BEG 38．64％和THP 18．46％，三者之间差异有统计学意义（χ^2=26．160，P〈0．05）。不良反应主要表现为膀胱刺激症状和血尿，BEG的不良反应发生率最高，其中9例症状严重放弃治疗。MMC组副作用最少，但是复发率最高。THP组有4例因为严重血尿而中断治疗，其余患者均完成治疗。结论吡柔吡星预防膀胱癌术后复发的疗效满意，患者耐受性好，副作用少，但要注意其严重血尿不良反应。卡介苗膀胱内灌注复发率其次，但膀胱刺激症状明显，有时可引起高热等全身症状，选择病例需谨慎。丝裂霉素复发率最高，但其副作用较少。联合药物膀胱灌注是将来发展趋势。

Objective To investigate the efficacy and safety of intravesical instillation of Bacillus cal -mette - guerin （BCG） and Mitomycin-C （MMC） and pirarubicin（THP） for preventing postoperative recurrence of superficial bladder cancer. Methods From Jan 1997 to Mar 2006,225 Patients with SUperficial transitional cell bladder cancer were divided into three groups：BCG group（53 cases）, MMC group（ 103 cases） and THP group（69 cases）. The instillation was used once a week for 8 weeks, then once two weeks for 8 times and then once a month for 24 months. All the patients were followed up for an average time of 11.8 ± 6.93 months. Results Three groups cancer recurrence rate were 38.64% （BCG）, 58.25% （MMC） and 18.46% （THP） respectively.There were significant difference among three groups（χ^2 = 26.160, P 〈 0.05. THP had lowest minimum of cancer recurrence rate. The side effects mainly included bladder irritation and blood urine. BCG had the most side effects,inclouding 9 cases give up treatment for serious general symptom. MMC had the least side effects,but its cancer recurrence rate was the highest. There were no significant difference in side effects between MMC and THP. THP has lowest minimum of cancer recurrence rate, but 4 cases give up treatment for serious blood urines. Conclusion THP is effective and well - tolerated for preventing cancer recurrence rate, but we have to pay attention to its serious blood urines. BCG has lower cancer recurrence rate, but its side effects is the highest even serious such as high fever symptom. Cases choosing for BCG need to prudent. MMC has lower side effects,but its cancer recurrence rate is the highest. Intravesical Instillatio drug in combined treatment for superficial bladder cancer is future trendency.