经尿道等离子双极膀胱肿瘤电切术联合吡柔比星术后膀胱灌注化疗治疗浅表性膀胱癌的效果

Effect of transurethral bipolar plasma resection of bladder tumor combined with postoperative intravesical instillation of pirarubicin in the treatment of superficial bladder cancer

目的观察经尿道等离子双极膀胱肿瘤电切术联合吡柔比星术后膀胱灌注化疗治疗浅表性膀胱癌的效果。方法70例浅表性膀胱癌患者,按随机数字表法分为对照组与实验组,各35例。对照组应用经尿道等离子双极膀胱肿瘤电切术治疗,实验组应用经尿道等离子双极膀胱肿瘤电切术联合吡柔比星术后膀胱灌注化疗治疗。比较两组患者治疗效果、并发症发生情况、肿瘤标志物[血管内皮生长因子(VEGF)、重组人Dickkopf相关蛋白1(DDK1)]水平、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平。结果对照组完全缓解8例,部分缓解11例,疾病稳定8例,疾病进展8例,缓解率为54.29%,控制率为77.14%;实验组完全缓解10例,部分缓解17例,疾病稳定6例,疾病进展2例,缓解率为77.14%,控制率为94.29%。实验组的缓解率与控制率均高于对照组,差异均具有统计学意义(P<0.05)。实验组的并发症发生率8.57%低于对照组的28.57%,差异具有统计学意义(P<0.05)。对照组治疗前的VEGF为(332.78±39.91)pg/ml、治疗后为(186.45±28.41)pg/ml,治疗前的DDK1为(5.68±0.77)ng/ml、治疗后为(3.20±0.61)ng/ml;实验组治疗前的VEGF为(335.28±40.05)pg/ml、治疗后为(143.99±21.83)pg/ml,治疗前的DDK1为(5.72±0.73)ng/ml、治疗后为(2.56±0.52)ng/ml。治疗前,两组患者VEGF、DDK1水平比较,差异均无统计学意义(P>0.05)。治疗后,实验组患者VEGF、DDK1水平均低于对照组,差异均具有统计学意义(P<0.05)。治疗后,实验组患者CD3^(+)(71.54±7.03)%、CD4^(+)(46.12±3.87)%、CD8^(+)(23.78±5.00)%、CD4^(+)/CD8^(+)(1.16±0.14)均优于对照组的(63.23±6.34)%、(31.65±3.01)%、(30.51±4.03)%、(0.83±0.08),差异均具有统计学意义(P<0.05)。结论经尿道等离子双极膀胱肿瘤电切术联合吡柔比星术后膀胱灌注化疗治疗浅表性膀胱癌的效果确切,可显著降低并发症发生率,且能改善患者的肿瘤标志物水平与免疫功能指标,值得推行。

Objective To observe the effect of transurethral bipolar plasma resection of bladder tumor combined with postoperative intravesical instillation of pirarubicin in the treatment of superficial bladder cancer.Methods A total of 70 cases of superficial bladder cancer patients were randomly divided into control group and experimental group,with 35 cases in each group.The control group was treated with transurethral bipolar plasma resection of bladder tumor,and the experimental group was treated with transurethral bipolar plasma resection of bladder tumor combined with postoperative intravesical instillation of pirarubicin.Both groups were compared in terms of therapeutic effect,occurrence of complications,tumor markers[vascular endothelial growth factor(VEGF),recombinant human Dickkopf-related protein 1(DDK1)]levels,immune function indicators(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)).Results In the control group,there were 8 cases of complete remission,11 cases of partial remission,8 cases of stable disease,and 8 cases of progressive disease,with a remission rate of 54.29%,and a control rate of 77.14%;in the experimental group,there were 10 cases of complete remission,17 cases of partial remission,6 cases of stable disease,and 2 cases of disease progression,with a remission rate of 77.14%and a control rate of 94.29%.The remission rate and control rate of the experimental group were higher than those of the control group,and the difference was statistically significant(P<0.05).The incidence of complications 8.57%in the experimental group was lower than 28.57%in the control group,and the difference was statistically significant(P<0.05).In the control group,VEGF was(332.78±39.91)pg/ml before treatment and(186.45±28.41)pg/ml after treatment,and DDK1 was(5.68±0.77)ng/ml before treatment and(3.20±0.61)ng/ml after treatment.In the experimental group,VEGF was(335.28±40.05)pg/ml before treatment and(143.99±21.83)pg/ml after treatment,and DDK1 was(5.72±0.73)ng/ml before treatment and(2.56±0.52)ng/ml after treatment.Before treatment,the differences were not statistically significant when comparing VEGF and DDK1 levels in both groups(P>0.05).After treatment,the VEGF and DDK1 levels in the experimental group were lower than those in the control group,and the differences were all statistically significant(P<0.05).After treatment,CD3^(+)(71.54±7.03)%,CD4^(+)(46.12±3.87)%,CD8^(+)(23.78±5.00)%,CD4^(+)/CD8^(+)(1.16±0.14)in the experimental group were better than(63.23±6.34)%,(31.65±3.01)%,(30.51±4.03)%,(0.83±0.08)in the control group,and differences were all statistically significant(P<0.05).Conclusion Transurethral bipolar plasma resection of bladder tumor combined with postoperative intravesical instillation of pirarubicin has definite effect in the treatment of superficial bladder cancer,which can significantly reduce the incidence of complications,and improve the level of tumor markers and immune function of patients.It is worthy of promotion.