新辅助介入化疗联合微创手术治疗浸润性膀胱癌

Neoadjuvant Interventional Chemotherapy Combined with Minimally Invasive Surgery for Muscle-invasive Bladder Cancer

目的 探讨新辅助介入化疗联合腔内手术治疗浸润性膀胱癌的临床效果.方法 对31例确诊为肌层浸润性膀胱癌（T2~4/G1~3）的患者行新辅助性介入化疗,先经股动脉入髂内动脉,尽可能到达供应肿瘤血管,给予丝裂霉素10 mg,吉西他宾1.0/m2,顺铂90 mg,明胶海绵暂时性封堵后拔管,1周后行经尿道膀胱肿瘤汽化电切术,术后即刻用丝裂霉素200 mg或吡柔比星40 mg膀胱灌注.结果 21例治疗1次,7例治疗2次（间隔1个月）,3例治疗3次（间隔1~2个月）.31例随访4个月~4年,平均36个月,2例术后6、10个月复发,再次重复治疗,1例因盆腔转移治疗2次后拒绝治疗,半年后死于肺转移,其余未见肿瘤复发.结论 对于局限浸润性膀胱癌的患者,采用新辅助性经髂内动脉插管介入化疗联合腔内手术治疗疗效满意.

Objective To explore the efficacy of neoadjuvant interventional chemotherapy combined with minimally invasive surgery for muscle-invasive bladder cancer. Methods Thirty-one cases of muscle-invasive bladder cancer （T2-4/G1-3） were treated with neoadjuvant interventional chemotherapy. After femoral artery catheterization, the catheter was inserted to the internal iliac artery with mitomycin C （MMC） 10 mg, vinorelbine 1. 0/m2, cisplatin 90 mg, and then was occluded by gelfoam before extubation. Transurethral resection of bladder tumor （TURBT） was conducted after 7 days and MMC 20 mg or pirarubicin 40 mg was irrigated into the bladder through catheter infusion immediately after operation. Results A total of 21 patients received one treatment, 7 patients two treatment （interval, 1 month） and 3 patients three treatments （interval, 1 -2 months）. Thirty-one cases were followed up for 4 months to 4 years （average, 36 months） ; during the period, 2 cases underwent repeated treatments due to recurrence 6 and 8 months after operation. One patient refused treatment after two treatments due to pelvic metastasis and died of pulmonary metastasis 6 months later. No recurrence was observed in the rest cases. Conclusion Neoadjuvant interventional chemotherapy combined with minimally invasive surgery is clinically effective for patients with local muscle-invasive bladder cancer.