髂内动脉化疗栓塞联合双极等离子电切术治疗大体积膀胱癌的临床应用

The clinical effect of internal ilium artery chemoembolization combined with bipolar transurethral resection in saline for large-sized bladder cancer

目的探讨髂内动脉化疗栓塞(TACE)联合经尿道双极等离子电切术(TURis)治疗直径≥3 cm高危肌层浸润性膀胱癌的临床疗效。方法选取不能或不愿接受膀胱全切手术的直径≥3 cm肌层浸润性膀胱癌患者58例为研究对象,采用抽签法随机分为对照组(A组)28例和观察组(B组)30例,A组单纯行传统术式经尿道膀胱肿瘤双极等离子电切术(TURis)治疗,B组采用经皮穿刺股动脉插管,实施髂内动脉TACE后2~3 d行TURis治疗,比较A组和B组的经尿道电切手术时间、术中出血量、导尿管保留时间、术后住院时间及术后3个月肿瘤复发率、术后2年肿瘤复发率、术后2年肿瘤特异生存率。结果B组30例患者均成功行TACE治疗,介入手术成功率100%。两组电切手术均顺利完成,无中转开放术式。58例患者均获得随访,平均随访25(10~38)个月。B组手术时间(45.8±7.5)min、导尿管留置时间(2.7±1.2)d、术后住院时间(3.5±1.4)d,分别短于A组手术时间(56.3±11.7)min、导尿管留置时间(3.8±1.5)d、术后住院时间(4.9±1.6)d;B组出血量为(55.4±8.2)mL低于A组(67.6±13.5)mL(P<0.05),差异均有统计学意义。B组术后3个月肿瘤复发率13.3%低于A组35.7%(P<0.05),B组术后2年肿瘤复发率53.3%明显低于A组78.6%(P<0.05),B组术后2年肿瘤特异生存率73.3%明显高于A组46.4%(P<0.05),差异有统计学意义。结论髂内动脉TACE联合TURis治疗直径≥3 cm的高危膀胱癌安全有效,明显减少术中出血,有利于肿瘤彻底切除,提高了保留膀胱功能患者的生活质量和肿瘤特异生存率。

Objective To evaluate the clinical effect of preoperative internal iliac artery chemoem-bolization combined with bipolar transurethral resection in saline(TURis)in treating high-risk muscle-invasive bladder cancer(MIBC)with diameter≥3 cm.Methods A total of 58 patients with≥3 cm MIBC,who was not able to or was not willing to receive total cystectomy,were enrolled in this study.By drawing lots method,the patients were randomly divided into group A(control group,n=28)and group B(observation group,n=30).Traditional TURis alone was adopted for the patients of group A,while internal iliac artery chemoembolization via femoral artery followed by TURis in 2-3 days was carried out for the patients of group B.The time spent for TURis procedure,the amount of intraoperative blood loss,the indwelling time of urine drainage tube,postoperative hospitalization days,3-month and 2-year postoperative tumor recurrence rate and 2-year postoperative cancer specific survival rate were compared between the two groups.Results Successful preoperative internal iliac artery chemoembolization was accomplished in all 30 p atients of group B,the success rate of interventional surgery was 100%.TURis operation was successfully completed in all patients of both groups,and no patient needed to be transferred to open surgery.All 58 patients were followed up for a mean of 25 months(10-38 months).In group B,the time spent for TURis procedure,the indwelling time of urine drainage tube and the postoperative hospitalization days were(45.8±7.5)min,(2.7±1.2)days and(3.5±1.4)days respectively,which were shorter than(56.3±11.7)min,(3.8±1.5)days and(4.9±1.6)days respectively in group A.The amount of intraoperative blood loss in group B was(55.4±8.2)mL,which was smaller than(67.6±13.5)mL in group A.The differences in the above mentioned items were statistically significant between the two groups(P<0.05 in all).The 3-month postoperative tumor recurrence rate in group B was 13.3%,which was lower than 35.7%in group A(P<0.05).The 2-year postoperative tumor recurrence rate in group B was 53.3%,which was strikingly lower than 78.6%in group A(P<0.05).The 2-year postoperative cancer specific survival rate in group B was 73.3%,which was obviously higher than 46.4%in group A,the difference was statistically significant(P<0.05).Conclusion For the treatment of≥3 cm large-sized MIBC,internal iliac artery chemoembolization combined with TURis is clinically safe and effective.This therapy can significantly reduce intraoperative bleeding,which is helpful to make complete excision of the tumor,to preserve bladder function,to improve the quality of life of patients,and to increase postoperative cancer specific survival rate.