新辅助化疗对高危非肌层浸润性膀胱癌行TURBT治疗患者的疗效观察

Effect of neoadjuvant chemotherapy on high-risk non-muscle-invasive bladder cancer treated with TURBT

目的 观察探讨行尿道膀胱肿瘤电切术(TURBT)前应用新辅助化疗对高危非肌层浸润性膀胱癌的疗效。方法 选取75例在本院确诊为高危非肌层浸润性膀胱癌患者,按随机数字表法分为观察组(37例)与对照组(38例)。对照组施行TURBT前不予以化疗,术后进行常规化疗;观察组则在术前采用新辅助化疗。比较两组临床疗效、围手术期各项指标、不良反应发生率以及复发率情况。结果 观察组治疗总有效率94.59%(35/37)高于对照组71.06%(27/38),差异具有统计学意义(χ^(2)=7.251,P<0.05);观察组的围手术期各项指标中,手术时间[(34.42±7.18)min]、术中出血量[(23.66±3.58)mL]、导尿管留置时间[(5.93±2.6)d]、住院时间[(10.89±4.3)d]分别低于对照组的(52.46±4.8)min、(48.97±7.83)mL、(7.61±2.1)d、(14.57±3.9)d,差异具有统计学意义(t=12.823、17.920、6.073、3.884,P<0.001);两组间下泌尿道症候群、胃肠道反应、骨髓抑制发生率相近,差异无统计学意义(χ^(2)=1.172、1.545、1.334,P>0.05);观察组在干预后6个月到两年内,病情总复发率(8.11%)明显低于对照组(26.31%),差异具有统计学意义(χ^(2)=4.997,P<0.05);结论 行TURBT前采用新辅助化疗对高危非肌层浸润性膀胱癌具有显著的抑制作用,能够降低术后复发率,且安全可靠,疗效显著,值得推广应用。

Objective To observe the effect of neoadjuvant chemotherapy before transurethral resection of bladder tumor(TURBT) on high-risk non-muscle-invasive bladder cancer.Methods A total of 75 patients with high-risk non-muscleinvasive bladder cancer in our hospital were randomly divided into an observation group(37 cases) and a control group(38cases). The control group did not receive chemotherapy before TURBT, but received routine chemotherapy after the operation;the observation group was treated with neoadjuvant chemotherapy before the operation. The clinical efficacy, perioperative indicators, incidence of adverse reactions, and recurrence rate were compared between the two groups.Results The total effective rate of the observation group was 94.59%(35/37) higher than 71.06%(27/38) of the control group, and the difference was statistically significant(χ^(2)= 7.251, P < 0.05). Among the perioperative indicators of the observation group, the operation time [(34.42 ± 7.18) min], intraoperative bleeding [(23.66 ± 3.58) ml], catheter retention time [(5.93 ± 2.6) d], and hospital stay [(10.89 ± 4.3) d] were lower than those of the control group [(52.46 ± 4.8) min,(48.97 ± 7.83) ml,(7.61 ± 2.1) d,and(14.57 ± 3.9) d], with statistically significant differences(t = 12.823, 17.920, 6.073, 3.884, all P <0.001). There were no significant differences between the two groups in the incidence rates of lower urinary tract syndrome, gastrointestinal reaction, and myelosuppression(χ^(2)= 1.172, 1.545, 1.334, all P > 0.05). From 6 months to 2 years after the intervention, the total recurrence rate of the observation group was(8.11%), which was significantly lower than that of the control group(26.31%),and the difference was statistically significant(χ^(2)= 4.997, P < 0.05).Conclusion Neoadjuvant chemotherapy before TURBT has a significant inhibitory effect on high-risk non-muscle-invasive bladder cancer, which can reduce the recurrence rate after the operation, and is safe, reliable, and effective, which is worth popularizing.