非肌层浸润性膀胱癌膀胱灌注治疗策略

Intravesical Instillation for Non-Muscle Invasive Bladder Cancer

经尿道膀胱肿瘤电切术(TURBT)后行膀胱灌注已经成为目前公认的预防和治疗非肌层浸润性膀胱肿瘤(NMIBC)最重要、最有效的手段。现阶段TURBT术后灌注治疗主要选择化疗药物和卡介苗(BCG)。对于所有非肌层浸润型的患者,术后及早期都应给予膀胱灌注治疗;对于G_(1～2)Ta期患者使用术后单次的化学药物灌注治疗即可;对于中危患者,推荐使用单次药物灌注+诱导灌注或持续灌注的治疗模式,但灌注药物使用的具体方案应根据患者具体情况制定相应的治疗计划;对于高危患者,术后应首选BCG的灌注治疗;化疗药物和BCG联合的序灌疗法对于治疗膀胱肿瘤有无优势,其疗效还需进一步验证。虽然膀胱药物灌注治疗的研究已经有很长的历史,但在药物的使用方面,如药物的选择,使用时间,及剂量方面仍没有统一的观点。本文对非肌层浸润型膀胱肿瘤TURBT术后膀胱灌注治疗的策略进行综述。

Intravesical instillation after transurethral resection of bladder tumor （TURBT） has been considered as the most important and effective method for the prevention and treatment of non-muscle invasive bladder cancer （NMIBC）.Nowadays, the main choices of intravesical instillation are chemical drugs and Bacillus Calmette-Guerin （BCG）.For all pa-tients with NMIBC, intravesical instillation should be admistered as soon as possible after TURBT.For patients of G_（1-2）T, an immediate single postoperative instillation of chemotherapy as standard therapy for low-risk disease is enough.For interme-diate-risk patients, it is recommended to use an immediate single postoperative instillation of chemotherapy plus an induc-tion course or maintenance treatment, but the scheme of intravesical instillation should be based on the specific circum-stances of the patients.For high-risk patients, maintenance therapy with BCG should be the first chioce.The combination of intravesical BCG and chemotherapy has certain advantages in treating NMIBC, but its efficacy needs further verifica-tion.Although there is a long history of intravesical instillation after TURBT, the choice of drugs, the time of instillation, and the corresponding dosages are still inconclusive.This article summarizes the strategies of the treatment for NMIBC after TURBT.