表浅膀胱肿瘤电切术后膀胱内药物灌注预防肿瘤复发的临床观察

Effect of intravesical instillation on the recurrence of bladder cancer after transurethral resection of superficial bladder cancer

目的观察表浅膀胱肿瘤电切术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的疗效和安全性。方法回顾性分析我科2007年2月至2009年10月间收治的130例表浅膀胱肿瘤患者的临床资料,所有患者均行经尿道膀胱肿瘤电切和术后膀胱内灌注丝裂霉素或吡柔比星,其中术后膀胱内灌注丝裂霉素70例,吡柔比星60例。观察术后1年肿瘤复发和灌注药物的副作用。结果①术后膀胱内灌注丝裂霉素和吡柔比星的1年复发率分别为11.4%(8/70)和16.7%(10/60)(P>0.05)。在丝裂霉素组,病理分级G1、G2、G3级肿瘤1年复发率分别为12.2%、8%和25%,它们之间无显著差异(P>0.05);在吡柔比星组,病理分级G1、G2、G3级肿瘤1年复发率分别为4%、12.5%和54.5%,其中G3级肿瘤复发率明显高于G1和G2级肿瘤(P<0.05)。②130例患者中,进行即刻膀胱内药物灌注(24h内)和非即刻灌注的1年复发率分别为4%(1/25)和16.2%(17/105),两者之间有显著性差异(P<0.05)。③灌注丝裂霉素和吡柔比星后全身副作用发生率分别为18.5%和1.5%(P<0.05),局部副作用发生率分别为4.3%和33.3%(P<0.05)。结论术后膀胱内灌注丝裂霉素和吡柔比星预防肿瘤复发的效果无显著性差异,但G3级肿瘤的复发率高于G1和G2级肿瘤,对其灌注方案有待进一步研究;术后即刻膀胱内药物灌注可有效降低肿瘤1年复发率,值得推广;术后膀胱内灌注丝裂霉素和吡柔比星的副作用在全身和局部发生率不同,但均可耐受;由于观察时间短和例数有限,观察结果有待进一步研究。

Objective To investigate the effects of intravesical instillation on the recurrence of bladder tumor after tran- surethral resection of superficial bladder cancer. Methods 130 patients underwent transurethral resection of superficial bladder cancer （T0--T1） and postoperative intravesical instillation of chemotherapeutic drugs in our department during Feb. 2007 to Oct. 2009. Among them,70 patients received mitomyein and 60 pirarubicin. One-year recurrence rate and side-effects of intravesical instillation of mitomycin and pirarubicin were analyzed. Results One-year recurrence rate was 11.4% in the mitomycin group and 16.7 % in the pirarubicin group （P〉0.05）. One-year recurrence rates of grade G1, G2, and G3 tumor were 12.2% ,8% ,and 25% in the mitomycin group and 4% ,12.5% ,and 54.5% in the pirarubicin group. Patients received immediate postoperative instillation of mitomycin or pirarubicin had a lower rate of recurrence [4 % （1/25）] than those who didn＇t receive immediate instillation [16.2%（17/105）, P（0.05]. The systemic side-effects of mitomycin and pirarubicin were 18.5% and 1.5% （P〈0.05） ,and the local side-effects were 4.3% and 33.3% （P〈0.05）. Conclusions The one-year recurrence rate is similar in patients with postoperative intravesical instillation of mitomycin and those with pirarubicin and chemotherapeutic drugs. Postoperative instillation of chemotherapeutic drugs is not effective on G3 tumor recurrence. Intravesical instillation of mitomycin mainly results in systemic reaction and pirarubicin mainly causes local reaction.