经尿道膀胱肿瘤绿激光汽化术联合髂内动脉介入栓塞化疗治疗高龄高危浸润性膀胱癌临床观察

Clinical observation of RPVBT combined with internal iliac artery chemoembolization in the treatment of muscle-invasive bladder cancer of elderly and high-risk patients

目的探讨应用根治性经尿道膀胱肿瘤绿激光汽化术(radical transurethral photoselective vaporization of bladder tumours,RPVBT)联合髂内动脉介入栓塞灌注化疗治疗肌层浸润性膀胱癌(T2N0M0)高龄、高危患者的临床疗效及安全性。方法选取因无法耐受或不愿接受根治性膀胱全切手术,而接受RPVBT或根治性经尿道膀胱肿瘤等离子切除术(radical of transurethral resection of bladder tumours,RTURBT),联合髂内动脉介入栓塞化疗的108例肌层浸润性膀胱癌(T2N0M0)患者资料。根据已实施术式不同,分为RTURBT组47例,RPVBT组61例,分析比较2组手术时间、术中出血量、闭孔反射情况、住院时间、生存率,复发率、以及总体髂内动脉介入栓塞化疗不良反应情况,绘制总体生存及无进展生存曲线。结果RPVBT组与RTURBT组患者年龄、Karnofsky评分、肿瘤最大直径、肿瘤数量、肿瘤分布位置、病理级别构成、性别构成等观测变量比较差异均无统计学意义(P>0.05)。RPVBT组患者术中出血量、手术时间、术后血尿时间、住院时间各观测变量显著优于RTURBT组患者,且未出现闭孔神经反射,差异均有统计学意义(P<0.001)。5年累积生存率、无进展生存率、累积复发率情况,RPVBT组分别为68.0%、43.3%、38.9%,RTURBT组分别为69.8%、47.8%、45.2%,2组比较差异无统计学意义(P>0.05)。2组复发特点以非浸润性复发为主(46.8%、42.6%),肌层浸润性复发率低(4.3%、4.9%)。总体髂内动脉介入栓塞化疗相关不良反应低、耐受性好。结论RPVBT联合髂内动脉介入栓塞化疗方案治疗肌层浸润性膀胱癌更微创、更小的不良反应、易耐受性、安全有效,有较满意的远期总体生存率,可作为高龄、高危无法耐受或不愿意接受根治手术患者的治疗策略。

Objective To investigate the clinical efficacy and safety of radical transurethral photoselective vaporization of bladder tumors(RPVBT)combined with internal iliac artery chemoembolization in the treatment of muscle-invasive bladder cancer(T2N0M0)in elderly and high-risk patients.Methods The clinical data were collected from 108 patients with muscle-invasive bladder cancer(T2N0M0),who chose to undergo RPVBT or radical transurethral resection ofbladder tumors(RTURBT)combined with internal iliac artery chemoembolization due to intolerance or reluctance to undergo radical cystectomy(RC).According to different types of surgical methods performed,they were divided into the RTURBT group(n=47)and the RPVBT group(n=61).The duration of operation,intraoperative blood loss,obturator nerve reflex,length of hospital stay,survival rate,recurrence rate and overall incidence of adverse effects after internal iliac artery chemoembolization were analyzed and compared between the two groups.Overall survival(OS)and progression-free survival(PFS)curves were drawn.Results There were no statistically significant differences between the RPVBT group and the RTURBT group in terms of age,Karnofsky score,maximum tumor diameter,tumor number,location for tumor distribution,pathological grade composition,and gender composition(P>0.05).In the RPVBT group,the observed variables of intraoperative blood loss,duration of operation,postoperative hematuria days,and length of hospital stay were significantly less or shorter than those in the RTURBT group,and no obturator nerve reflex occurred,suggesting significant differences(P<0.001).The 5-year cumulative survival rate,PFS rate,and cumulative recurrence rate were 68.0%,43.3%,and 38.9%in the RPVBT group,and 69.8%,47.8%,and 45.2%in the RTURBT group,respectively,and there was no statistically significant difference between two groups(P>0.05).The recurrence characteristics of the two groups were mainly non-invasive recurrence(46.8%vs.42.6%),and the recurrence rate of muscular invasive bladder cancer was lower(4.3%vs.4.9%).The adverse reactions overall related to internal iliac artery chemoembolization were low,with good tolerance.Conclusion RPVBT combined with internal iliac artery chemoembolization is more minimally invasive,which has low complications,good tolerance,good safety and effectiveness in the treatment of muscle-invasive bladder cancer.With a satisfactory long-term OS rate,RPVBT can be used as a treatment strategy for high-risk elderly patients who are intolerant or unwilling to undergo radical surgery.