吡柔比星黏膜下注射加单次灌注预防膀胱癌复发

Submucosal injection plus single intravesical instillation of pirarubicin to prevent bladder carcinoma recurrence

目的:探讨吡柔比星(THP)黏膜下注射加单次灌注预防膀胱癌术后复发的临床疗效和安全性.方法:膀胱癌65例,均行膀胱部分切除术,随机分为A,B两组,A组:34例,术中THP多中心黏膜下注射,并行膀胱灌注1次;B组:31例,术后定期THP膀胱灌注.65例患者随访1～7(平均3.4)a.结果:A组3例复发,复发率8.8%(3/34);6例出现膀胱刺激症状或血尿,发生率17.6%(6/34).B组9例复发,复发率29.0%(9/31);13例出现不良反应,发生率41.9%(13/31).两组复发率和不良反应发生率的差异均有统计学意义(P<0.05).结论:手术同期黏膜下注射加单次膀胱灌注THP是预防膀胱癌术后复发的有效方法,具有不增加患者痛苦、一次完成、操作简单、费用低、安全、副作用少等优点.

AIM： To evaluate the efficacy and security of submucosal injection plus single intravesical instillation of pirarubicin for prevention of bladder cancer recurrence. METHODS： A total of 65 patients with bladder cancer underwent partial cystectomy and were randomly divided into 2 groups. In group A, submucosal multiple injections plus single intravesical instillation of pirarubicin were conducted in 34 cases intraoperatively. In group B, intravesical perfusion of pirarubicin was performed in 31 cases regularly after operation. All the patients were followed up for 1 to 7 years （ mean 3.4 years）. RESULTS ： The recurrence rate was 8.8% （3/34）in group A, and 29.0% （9/31）in group B. The adverse effect rate was 17.6% （6/34） in group A, and 41.9% （13/31）in group B, including irritation signs of bladder and hematuria. No serious complications occurred. There was significant difference in recurrence rate and adverse effect rate between the 2 groups （ P 〈 0.05 ）. CONCLUSION ： Intraoperative submucosal injection combined with single intravesical instillation of pirarubicin is an effective procedure for the prevention of bladder cancer recurrence. It is simple, safe, less painful, less expensive and has fewer side effects.