经尿道膀胱肿瘤电切联合化疗治疗浸润性膀胱癌(附20例报告)

Efficacy of transurethral resection of bladder tumors in combination with chemotherapy in the treatment of invasive bladder cancer

目的：探讨经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor, TURBT）联合膀胱灌注化疗及静脉化疗治疗浸润性膀胱癌的临床疗效。方法影像及病理均明确诊断为浸润性膀胱癌不能耐受或拒绝行根治性膀胱切除术患者20例,肿瘤直径1.8∽5.0 cm,病理分级 G211例,G39例,TNM分期T2a 9例,T2b 10例,T4a 1例。采用 TURBT切除肿瘤至膀胱壁外脂肪层,其中1例肿瘤侵犯前列腺者同时行经尿道前列腺电切术,切除范围至肿瘤基底部周围2 cm正常膀胱黏膜。术后 GC方案（吉西他滨＋顺铂）静脉化疗,每三周为1个周期；吡柔比星膀胱灌注化疗,每周一次。每三个月复查膀胱镜评估肿瘤复发情况。结果20例患者手术顺利,手术时间35∽100 min,围手术期未见严重并发症。术后病理报告均为浸润性尿路上皮癌。化疗后出现白细胞下降4例,恶心、食欲减退等胃肠道反应6例,对症处理后均好转。术后随访3∽24个月,平均12个月。术后6个月复发1例,术后12个月复发1例,术后24个月复发1例。复发病例中T4a 1例,T2b 2例。术后6个月复发者死于肿瘤远处转移。结论 TURBT 联合化疗治疗浸润性膀胱癌有一定疗效,可作为保留膀胱的一种综合治疗方法。

Objective To evaluate the clinical efficacy of transurethral resection of bladder tumor （TURBT）combined with intravesical chemotherapy and intravenous chemotherapy for inva-sive bladder cancer. Methods 20 patients,who were diagnosed with invasive bladder cancer by Imaging and pathology and not tolerating or refusing radical cystectomy were treated by TURBT.Of the 20 patients,the tumor diameters were 1.8 to 5.0 cm,11 cases were G2 and 9 cases were G3 , while TNM stage T2a 9 cases were in T2a stage,10 cases in T2b and 1 case in T4a stage.The tumors were resected to the bladder wall outer layer of fat,while transurethral resection of the prostate was simultaneous performed in 1 case with prostatic invasion.Postoperative GC schedule （gemcitabine ＋cisplatin）chemotherapy was implemented every three weeks as a cycle;Pirarubicin intravesical chemotherapy was administered once a week.Cystoscopy was performed every three months to as-sess the tumor recurrence. Results The tumors of 20 patients were resected completely.Opera-tive time ranged from 35 to 100 min,no serious complications occurred during the operation.The patients were confirmed as invasive transitional cell carcinoma by pathological examination.After chemotherapy,leukopenia appeared in four patients,and gastrointestinal reactions such as nausea or loss of appetite occurred in six patients,which were improved after symptomatic treatment.Patientsnbsp;were followed up from 3 to 24 months （average of 12 months）.During the follow-up period,recurrence happened in three pa-tient after 6 months,12 months and 24 months respectively,while 1case died of bladder cancer metastasis. Conclusions TURBT in combination with chemotherapy is quite efficient for invasive bladder cancer patients and can be used as a compre-hensive treatment for bladder perservation.