髂内动脉化疗栓塞联合经尿道膀胱肿瘤电切术治疗晚期膀胱癌17例

Internal iliac artery chemoembolization combined with transurethral electrocoagulation resection for advanced bladder cancer: preliminary results in 17 cases

目的评价经髂内动脉灌注化疗并栓塞治疗后联合经尿道膀胱肿瘤切除治疗晚期膀胱癌的疗效。方法对17例经CT检查及膀胱镜下肿块活检病理证实为肌层浸润的晚期膀胱移行细胞癌的患者,采用行经皮穿刺股动脉插管,用选择性插管技术经髂内动脉灌注化疗栓塞后再行经尿道膀胱肿瘤电切治疗膀胱癌17例。结果 17例晚期膀胱癌患者行经髂内动脉化疗栓塞治疗后,14例肿瘤体积有不同程度的缩小,3例术后肿块无明显改变,但血尿症状有明显减轻。17例患者均行经尿道膀胱肿瘤电切治疗,术后存活10～62(平均43.5)个月。结论对于老年晚期膀胱癌患者,可选择采用髂内动脉化疗栓塞治疗能缩小肿瘤体积,明显减少围手术期出血,结合经尿道膀胱肿瘤电切术,能延长患者的生存时间,改善其生活质量,可以最大限度保留膀胱功能,并发症较少,是一种安全有效的姑息性治疗方法。

Objective To evaluate the internal iliac artery chemoembolization combined with transurethral electrocoagulation resection in treating advanced bladder cancer. Methods A total of 17 patients with advanced bladder transitional cell carcinoma, which pathologically showed malignant invasion of muscular layer, were enrolled in this study. The diagnosis was confirmed by CT scanning and cystoscopic biopsy. Selective catheterization and internal iliac artery chemoembolization was performed in all patients, which was followed by transurethral electrocoagulation resection of the bladder cancer. The clinical efficacy and the survival time were analyzed. Results After internal iliac artery chemoembelization the tumor was decreased in size in different degree in 14 patients, while no obvious reduction in tumor＇s size was seen in 3 patients. Clinically, the symptom of hematuria was remarkably improved in all patients. Transurethral electrocoagulation resection of the bladder cancer was subsequently carried out in all the 17 patients. After the treatment the mean survival time was 43.5 months （ranged from 10 to 62 months）. Conclusion For elderly patients with advanced bladder cancer internal iliac artery chemoembolization can obviously reduce the tumor＇s volume and significantly reduce the bleeding during the perioperative period. If transurethral electrocoagulation resection of the bladder cancer is subsequently carried out, the patient＇s survival time can be effectively elongated and the living quality can be distinctly improved. Moreover, as a safe and effective palliative treatment this therapy can preserve the bladder function to the greatest possible advantage and carries rather fewer complications.