保留膀胱联合髂内动脉化疗治疗浸润性膀胱癌46例报告

Bladder-sparing Surgery Combined Internal Iliac Artery Chemotherapy for Invasive Bladder Cancer(Report of 46 Cases)

目的:评价保留膀胱手术后联合髂内动脉介入化疗治疗浸润性膀胱癌的临床疗效。方法:2003年6月～2009年2月对46例浸润性膀胱移行细胞癌患者采用经尿道膀胱肿瘤电切或膀胱部分切除术联合顺铂+吡喃阿霉素方案髂内动脉化疗进行治疗。结果:46例患者均获得随访,平均随访38(9～68)个月。33例无瘤生存,2例带瘤生存,11例死于肿瘤转移,5年生存率为75.76%;29例保留膀胱生存,10例行挽救性全膀胱切除,其中全膀胱切除术后死亡4例,5年膀胱保存率为73.32%;其中33例T_2期患者5年生存率为83.21%;5年膀胱保留率为81.82%。全部患者对动脉化疗耐受良好,无严重全身和局部不良反应。结论:保留有功能的膀胱手术加髂内动脉灌注化疗为治疗浸润性膀胱移行细胞癌的有效方法之一,尤其是早期浸润性膀胱癌(T_2期)患者,是保留膀胱治疗的最佳适应证。

Objective：To evaluate the clinical effect of bladder sparing surgery combined with internal iliac artery chemotherapy for patients with invasive bladder cancer. Methods： From June 2003 to February 2009, 46 patients with invasive bladder cancer were treated with transurethral resection of bladder tumor or partial eystectomy combined with internal iliac artery chemotherapy. The chemotherapy regimen consisted of IDDP and epirubicino The bladder preservation and survival rate of these patients were analysised. Results：46 patients were followed up for 9--68 months with a average of 38months. 33 of 46 patients survived without tumor and 2 patients survived with tumor. 11 patients died of metastatic disease,the 5-year survival rate was 75.76% ; 29 patients survived with functional bladder, salvage cystectomy were performed for local failure in 10 patients, 4 died after total cystecto my. The 5-year survival rate with bladder-preservation was 73.32% ; in 33 cases with T2 carcinoma, the 5-year survival rate was 83.21% and the 5-year survival rate with bladder preservation was 81.82 %. Intra arterial chem otherapy with DDP and THP regimen was well tolerated without severe systemic or local toxicities. Conclusions：In ternal lilac artery chemotherapy is effective and useful for some bladder cancer with the bladder function preserved, for the early invasive bladder cancer （T 2 period） patients particularly. It is to retain the best indication of bladder treatment.