根治性经尿道电切联合化疗治疗肌层浸润性膀胱癌的临床疗效观察

Clinical efficacy of radical of transurethral resection of bladder tumors combined with chemotherapy in the treatment of muscle invasive bladder cancer

目的目前肌层浸润性膀胱癌的发病率呈上升趋势,根治性膀胱切除术创伤大、出血多、术后生活质量差,部分患者拒绝或不愿行根治性膀胱切除术。本研究探讨应用根治性经尿道等离子电切术(radical of transurethral resection of bladder tumor,RTURBT)联合膀胱灌注化疗及全身化疗治疗肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC)的疗效和安全性。方法回顾性分析章丘市中医医院2009-01-01-2014-01-01收治的24例MIBC患者的临床资料。24例患者均在全麻或腰硬联合麻醉下行RTURBT术。辅助治疗于术后2周开始,给予吡柔比星30 mg膀胱灌注(1次/周,共8次,随后1次/月,共1年)及吉西他滨1 000 mg/m^2(d_1、d_8、d_(15),静脉滴入)联合顺铂70 mg/m^2(d_2,静脉滴入)静脉化疗,4周为1个周期,共4个周期。结果 24例患者均顺利完成手术,术中平均出血80.3 mL(50~180 mL),术中及术后无严重并发症。术后病理,低级别浸润性尿路上皮癌10例,高级别浸润性尿路上皮癌14例,肿瘤侵犯浅肌层13例,侵犯深肌层11例,基底部均未查见癌。膀胱灌注化疗及全身化疗耐受良好,不良反应多为胃肠道反应(22例)、骨髓抑制(19例)和尿路刺激症状(17例),对症处理后,所有患者均完成治疗。治疗后24例患者均获随访,术后随访12~60个月,平均30个月。复发7例(29.2%),首次复发中位时间为术后10.5个月(5.0~26.0个月)。3例(12.5%)患者死亡,2例(8.3%)死于远处转移,1例死于脑血管疾病。结论行RTURBT联合化疗治疗MIBC的创伤小、出血少、安全性高,是MIBC患者可以选择的治疗方法。

OBJECTIVE The incidence of muscle invasive bladder cancer （MIBC） is on the rise. Its traditional treatment is radical cystectomy. There are a lot of problems with this treatment, such as great trauma, postoperative bleeding, poor quality of life. The patients with MIBC are not willing to accept or even reject the treatment. The objective of this study was to investigate the efficacy and safety of radical of transurethral resection of bladder tumor （RTURBT） combined with chemotherapy for the treatment of muscle invasive bladder cancer （MIBC）. METHODS A retrospective study was carried out in a series of 24 patients with MIBC treated from January 1,2009 to January 1,2014. Preoperative cystoscopy and biopsy of the bladder were performed and pathologic diagnosis were urinary tract epithelial carcinoma. Clinic TNM classification was T2 No M0 by pelvic CT scan or bladder MRI. Totally 24 patients were operated by RTURBT with general anesthesia or combined spinal epidural anesthesia. Postoperative bladder instillation of Pirarubicin （30 mg） and systemic chemotherapy of Gemcitabine （1 000 mg/m^2 ） combined with Cisplatin （70 mg/m^2 ） were given. RESULTS Operations of all 24 patients were completed with no severe complication. The pathology findings： 10 cases were low grade infiltrating ductal urothelial carcinoma, 14 cases were high grade infiltrating ductal urothelial carcinoma. Tumor invasion of superficial muscular layer was in 13 cases. Tumor invasion of deep muscle layer was in 11 cases. Intravesical chemotherapy and systemic chemotherapy were well tolerated. The main side reactions were gastrointestinal reaction（22 cases） and bone marrow suppression （19 cases） and urinary tract symptoms （17 cases）. All patients completed the treatment. Follow-up time were 12--60 months after operation, with an average of 30 months. The recurrence was in 7 cases, the first tumor recurrence time was 5--26 months and the median time was 10.5 months. Six recurrent patients received re-RTURBT, 1 recurrent patient received radical cystectomy. Three patients died, of whom 2 cases died from metastasis and 1 case died from cerebrovascular disease. CONCLUSION RTURBT combined with chemotherapy in the treatment of MIBC has sat-isfied clinical efficacy with advantages of less injury, less bleeding and high safety.