TURBt术后灌注化疗对预防复发的长期疗效观察

Observation of Longterm Effects of Perfusion Chemotherapy on Preventing Against Recrudesce of Cancer in Patients with Transurethral Resection of Bladder Tumor

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有效性。方法将64例浅表性膀胱癌患者TURB t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,40 mg/次,每周1次共8次,以后每2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 TURB t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,THP是较为理想的膀胱灌注化疗药物。

Objective To evaluate the long-term efficacy of transurethral resection of bladder tumor（TURBT） combined with intravesical pirarubicin（tetrahydropyranyl adriamycin,THP） to prevent recurrence of superficial bladder cancer.Methods Sixty four patients with superficial bladder cancer were divided into 2 groups after TURBt surgery.The observation group was given intravesical THP 1 week after surgery,the dosage is 40 mg,once a week,totally 8 times;after that,once every two weeks,totally 8 times;and then once a month till 2 years after surgery.The control group（15 cases） was those who refused to accept intravesical THP or intravesical THP for only 1-2 times.During the follow-up,the cystoscopy examination was used to observe the recurrence rate at 1 year,3 years,5 years and 7 years.Results Sixty patients had been monitored.4 patients lost to follow up.The follow up was 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 were 10.2%,16.3%,22.4% and 34.7%,respectively;In control group,11 patients were monitored,the recurrence rate for 1 year,3 years,5 years and 7 years were 36.4%,54.5%,63.6% and 72.7%,respectively.In the observation group,the average time for first relapse was 47 months;while in the control group,it was 26 months.Conclusion Intravesical THP after TURBt can prevent the 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.