丝裂霉素C术中应用对膀胱癌术后复发部位的影响

Influence on the postoperative recurrence site in bladder cancer treated with Mitomycin C during Surgery

目的:探讨低剂量丝裂霉素C(MMC)术中肿瘤基底部注射联合即刻膀胱灌注或联合膀胱粘膜下注射对膀胱癌(BC)术后复发部位变化及其治疗方式的影响。方法:73例膀胱移行细胞癌初发病例,均接受保留膀胱手术。术中随机分成三组:A组采用低剂量MMC(10mg,0.10g/l)术中肿瘤基底部注射联合膀胱即刻灌注27例,B组采用相同剂量的MMC术中肿瘤基底部注射联合膀胱粘膜下注射22例,C组24例仅MMC((0.40g/l))术后定期膀胱灌注治疗。术后随访12～60个月。结果:A组原位复发1例,异位复发2例,复发率(RR)11.11%。B组原位和异位复发各1例,RR9.09%。C组原位复发8例,RR为37.50%。治疗期间,有39例发生局部反应,未见膀胱粘膜坏死、骨髓抑制等严重并发症。结论:低剂量MMC术中肿瘤基底部注射联合即刻膀胱灌注或联合膀胱粘膜下注射,其疗效均明显优于单纯MMC术后定期膀胱灌注治疗。

Objective To discuss influence of injecting into the tumour base plus perfusing inside bladder instantly or injecting bladder mucous membrane during surgery on the postoperative recurrence site and treatments of bladder cancer （BC）by low dose Mitomycin C（MMC）. Methods A total of 73 cases which had initial transitional cell cancer were treated with bladder-sparing surgery. These cases were divided randomly into 3 groups： 27 cases in Group A were treated with injecting into the tumour base and perfusing inside bladder instantly by low dose MMC （10mg,0.10g/L）during surgery, 22 cases in Group B were treated with injecting into the tumour base and widespreadly into the bladder mucous membrane by low dose MMC during surgery, 24 cases in Group C were only perfused regularly with MMC（0.40g/l） after surgery. Follow-up ranged from 12 to 60 months. Results For recurrence cases, 1 case in Group A recurs in situ relapse, 2 cases recur ecotopic relapse, the recurrence rate （RR） was ll.ll%,stage of 1 case and grade of 1 case had progressed respectively; 1 case in Group B recur in situ and ecotopic relapse repectively, the RR was 9.09%, the stage of 1 case had progressed;8 cases in Group C recur in situ relapse, 1 case recurs ecotopic relapse, the RR was 37.50%,the stage of 8 cases and grade of 3 cases had progressed. In treatment period, 39 cases of all cases had partial response, but these cases had not any serious complication. Conclusion The efficacy of injecting into the tumour base plus perfusing inside bladder instantly or injecting bladder mucous membrane widespreadly during surgery by low dose MMC is better than that of perfus- ing MMC regularly inside bladder alone after operation.