绿激光汽化术后早期膀胱灌注预防膀胱癌复发的临床观察

Early intravesical chemotherapy for prophylaxis of superficial bladder carcinoma after greenlight photoselective vaporization

目的探讨早期应用吡柔比星膀胱灌注预防浅表性膀胱癌绿激光汽化术后复发的疗效及安全性。方法对采用经尿道膀胱肿瘤绿激光汽化术治疗浅表性膀胱癌患者117例术后随机分为早期膀胱灌注化疗组(Ⅰ组)和常规膀胱灌注化疗组(Ⅱ组)。Ⅰ组63例,术后6小时内应用吡柔比星行膀胱灌注化疗1次,术后1周开始规律膀胱灌注化疗;Ⅱ组54例,术后1周开始应用吡柔比星常规膀胱灌注化疗。比较两组患者的膀胱肿瘤复发率、肿瘤复发时间及灌注化疗不良反应情况。结果随访14-52月,平均34月。Ⅰ组8例复发(12.7%),复发时间为(684±221)天:术后第1年0例复发,术后第2年5例复发,2年后3例复发;Ⅱ组15例复发(27.8%),复发时间为(526±260)天:术后第1年5例复发,术后第2年6例复发,2年后4例复发。两组比较,Ⅰ组的肿瘤复发率及术后第1年肿瘤复发率明显低于Ⅱ组,差异有统计学意义(P<0.05);但两组的肿瘤复发时间、术后第2年及2年后的肿瘤复发率差异无统计学意义。膀胱灌注化疗不良反应包括膀胱刺激症状、肉眼血尿等,两组比较差异无统计学意义。结论浅表性膀胱癌绿激光汽化术后早期应用吡柔比星膀胱灌注化疗可有效降低术后肿瘤复发率,特别是降低术后早期复发风险,且不增加灌注化疗不良反应。

Objective To investigate the effectiveness and safety of early intravesical instillation of pirarubicin for prophylaxis of superficial bladder carcinoma after greenlight photoselective vaporization.Methods 117 patients diagnosed with superficial bladder carcinoma were treated by greenlight photoselective vaporization.The patients were randomly divided into two groups：63 patients were treated with intravesical instillation of pirarubicin within 6h after greenlight photoselective vaporization,followed by regular intravesical instillation（group Ⅰ）;54 were treated with regular intravesical instillation of pirarubicin one week after operation（group Ⅱ） .The patients were followed up for 14 to 52 months（mean 34 months）;the recurrence rate,recurrence time and side effects were compared between the two groups.Results In group Ⅰ,8 cases had recurrence（12.7%） ,the time of recurrence was（684±221） days,no case relapsed in the first year,5 cases in the second year and 3 cases after 2 years.In group Ⅱ,15 cases had recurrence（27.8%） ,the time of recurrence was（526±260） days,5 cases relapsed in the first fellow-up year,6 cases in the second year,4 cases after 2 years.The recurrence rate and recurrence rate during the first fellow-up year were significantly lower in group Ⅰcompared with those in group Ⅱ（P〈0.05） .There were no significant differences in recurrence time,recurrence rate in the second year and after 2 years between the two groups.There was no difference in the incidence of side effects between the two groups.Conclusion Early intravesical instillation of pirarubicin after greenlight photoselective vaporization can reduce early recurrence of bladder cancer without increasing the incidence of side effects.