经尿道铥激光汽化切除术联合高选择膀胱动脉化疗栓塞术治疗高龄、高危浸润性膀胱癌的临床研究

Clinical study of transurethral thulium laser vaporization combined with highly selective bladder artery chemoembolization for the treatment of high-risk invasive bladder cancer in the elderly

目的探讨经尿道铥激光汽化切除术联合高选择膀胱动脉化疗栓塞术治疗高龄、高危浸润性膀胱癌的疗效。方法选取2014年10月至2018年3月高龄、高危浸润性膀胱癌患者45例,其中大多数患者无法耐受全膀胱切除的手术创伤、风险及并发症,少数患者主观不愿切除膀胱;按照治疗方式不同分为A组(观察组)和B组(对照组)。A组采用经尿道铥激光切除术联合高选择性膀胱动脉化疗栓塞术,B组采用单纯铥激光切除术。两组术后采用相同膀胱灌注化疗。比较两组患者的术中出血总量、肿瘤切除时间、术后尿管留置时间、住院总时间。随访2年后比较两组患者的复发率、生存率,并记录不良反应发生情况和术前、术后病理分期及分级情况。结果A组术中出血量小于B组术中出血量,A组手术时间、尿管留置时间和住院天数均比B组相对应的手术时间、尿管留置时间和住院天数短,差异有统计学意义(P<0.05)。随访2年,A组6、12、24个月的复发率均低于B组,差异有统计学意义(P<0.05)。随访12、24个月的生存率,A组的无复发生存率(RFS)和平均无复发时间均高于B组,差异有统计学意义(P<0.05),但2年内的总体生存率和平均总体生存时间均无差异(P>0.05)。A组肿瘤分期下降的比例为31.8%,病理分级下降的比例为22.7%,B组中未发现病理降期、降级情况。结论经尿道铥激光汽化切除术联合高选择膀胱动脉化疗栓塞术是治疗高龄、高危浸润性膀胱癌的一种可选择、有效的保留膀胱的治疗方法,可降低肿瘤复发率,延长RFS并可使部分肿瘤降期、降级。

Objective To investigate the clinical efficacy of transurethral thulium laser vaporization combined with highly selective bladder artery chemoembolization for the treatment of high-risk invasive bladder cancer in the elderly.Methods We selected 45 elderly patients with high-risk invasive bladder cancer from October 2014 to March 2018,all of whom were unable to tolerate or unwilling to undergo total cystectomy.These patients were randomly divided into Observation group(group A)and Control group(group B).The group A received transurethral thulium laser resection combined with highly selective chemoembolization of bladder artery,while the group B received thulium laser resection alone.The two groups were treated with bladder perfusion chemotherapy in the same way.Surgical indicators were compared including:total in traoperative bleeding,tumor resection time,postoperative catheter indwelling time,and total hospitalization time.The recurrence rate and survival rate of the two groups were compared,and the adverse reactions,preoperative and postoperative pathological stages and grades were recorded.Results The amount of intraoperative bleeding in group A was less than that in group B.In the group A,operation time,catheter indwelling time and length of stay were all shorter than those in the group B,which the statistical the differenve was significant(P<0.05).The recurrence rate in the 2-year follow-up group A at 6,12 and 24 months were lower than those in the group B at 6,12 and 24 months,and the difference was statistically significant(P<0.05).The survival rate was followed up at 12 months and 24 months.The relapse-free survival rate and mean survival time of the group A were higher than those of group B,with statistical significance(P<0.05).However,there was no significant difference in the overall survival rate or mean survival time within 2 years(P>0.05).Tumor stage decline rate in group A was 31.8%and pathological grade decline rate was 22.7%.In the group B,no preoperative or postoperative pathological decline was found.Conclusions Transurethral thulium laser vaporization resection with highly selective bladder arterial chemoembolization in the treatment of high-risk invasive bladder cancer in the elderly is an effective and safe choice,and preservation of bladder can reduce tumor recurrence rate,prolong relapse-free survival and receive descending in tumor stage and grade.