TURBt术联合吡柔比星膀胱灌注治疗对预防浅表性膀胱癌术后复发的长期疗效观察

目的评价经尿道膀胱肿瘤电切术(TURBt)联合吡柔比星(THP)膀胱内灌注预防浅表性膀胱癌复发的长期疗效。方法 64例浅表性膀胱癌患者TURBt术后分为两组,一组采用术后1周开始行吡柔比星膀胱灌注治疗,每次40mg,每周1次共8次,以后每两周1次,共8次,以后每月1次持续到术后2年。对照组为术后拒绝进行吡柔比星膀胱灌注或灌注仅1～2次者。定期膀胱镜检查进行随访,观察其在1年、3年、5年、7年时的肿瘤复发率。结果果随访60例患者,4例失访,随访时间18个月～11年,平均78个月。64例中坚持灌注治疗2年者49例,术后1年、3年、5年、7年时的肿瘤复发率分别为10.2%,16.3%,22.4%,34.7%;对照组15例,随访11例,术后1年、3年、5年、7年时的肿瘤复发率分别为36.4%,54.5%,63.6%,72.7%。维持灌注组首次复发时间平均为47个月,对照组平均复发时间为26个月。结论 TURBt术后膀胱灌注THP预防浅表性膀胱癌术后复发近期及远期疗效确切,患者耐受性好,可有效降低膀胱癌的近期及远期复发率,是较理想的膀胱灌注化疗药。

Objective To evaluate the long-term efficacy of Transurethral Resection of Bladder Tumor（TURBt） combined with Intravesical Pirarubicin（THP） to prevent recurrence of superficial bladder cancer.Methods 64 patients with superficial bladder cancer were divided into 2 groups after TURBt surgery.1 group to give intravesical THP 1 week after surgery,the dosage is 40mg,once a week,totally 8 times;then once every two weeks,totally 8 times;then once a month till 2 years after surgery.The control group were those who refused to accept intravesical THP,or intravesical THP for only 1-2 times.Periodically gave cystoscopy examination during follow-up visit to observe the recurrence rate at 1 year,3 years,5 years and 7 years.Results 60 patients have been monitored.4 patients have drop-off.The follow up duration are 18 months to 11 years,average 78 months.Among the 64 patients,49 patients received intravesical THP for 2 years,the recurrence rate for 1 year,3 years,5 years and 7 years are 10.2%,16.3%,22.4%,and 34.7%;15 patients are in control group,11 patients have been monitored.The recurrence rate for 1 year,3 years,5 years and 7 years are 36.4%,54.5%,63.6%,and 72.7%.In the intravesical group,the average time for first relapse is 47 months;in the control group,the average time for first relapse is 26 months.Conclusion Intravesical THP after TURBt can prevent relapse of superficial bladder cancer after surgery in the short term and long term.Patients are well-tolerated.The treatment can effectively reduce the short term and long term recurrence rate for bladder cancer and can be used as ideal intravesical chemotherapy.