钬激光联合吡柔比星灌注治疗浅表性膀胱癌

Clinical study of holmium laser resection as well as instant intravesical Pirarubicin instillation for superficial bladder carcinoma

目的探讨经尿道钬激光切除联合吡柔比星即刻灌注治疗浅表性膀胱癌的临床疗效。方法51例浅表性膀胱癌患者按随机数字表法分为两组，治疗组26例行经尿道膀胱肿瘤钬激光切除，术后即刻予以膀胱内保留灌注无菌蒸馏水50ml＋吡柔比星30mg，1次；对照组25例行经尿道膀胱肿瘤电切治疗，两组术后拔除尿管时灌注1次，以后每周1次，共8次，后改为每月1次，持续至术后1年以上，随访15—39个月。结果治疗组手术时间20—53min，平均（31．6±8．9）min，无膀胱穿孔发生，术后留置导尿管1—5d，平均（2．7±0．6）d，4例复发；对照组手术时间13—47min，平均（29．8±8．3）min，1例术中膀胱穿孔，术后留置导尿管3—11d，平均（4．6±1．1）d，11例复发。两组平均手术时间、膀胱穿孔例数差异均无统计学意义（均P〉0．05），治疗组术后导尿管留置时间、肿瘤复发例数均低于对照组（均P〈0．05）。结论经尿道钬激光切除联合吡柔比星灌注治疗浅表性膀胱肿瘤疗效优于电切治疗，术后恢复快。

Objective To study the efficacy of transurethral holmium laser resection as well as instant intravesical Pirarubicin instillation for superficial bladder carcinoma. Methods 51 cases with superficial bladder cancer were divided into observation group（A） including 26 cases and control group（B） including 25 cases stochastically. The 26 cases of group A were received transurethral holmium laser resection as well as instant intravesical Pirarubicin instillation therapy whereas 25 cases of group B received transurethral resection therapy. All patients of both groups were treated with intravesical instillation of Pirarubicin therapy regularly at least 1 year and have been followed up for 15 to 39 months. Results Differences were not significant between the two groups in the mean operation time and bladder perforation rate （P 〉 0.05 ）, but indwelling period of urethral catheter was markedly decreased in group A than group B（P 〈0.05）. There were 4 cases of recurrence in group A,recurrence rate was 15.4% （4/26）. While there were 11 cases of recurrence in group B, recurrence rate was 44.0% （11/25 ）. Significant difference in cancer recur- rence rate was found between two groups （ P 〈 0.05 ）. Condusion Compared with transurethral resection therapy transurethral holmium laser resection as well as instant intravesical Pirarubicin instillation for superficial bladder carcinoma was more effective and quicker recovery, which has a good applied future in the clinical practice.