尿毒症合并非肌层浸润性膀胱癌患者术后膀胱灌药方法的研究

Study on the method of bladder perfusion in patients with uremia complicated with non-muscular invasive bladder cancer after operation

目的探讨不同膀胱灌注化疗药物对减轻尿毒症合并非肌层浸润性膀胱癌患者术后不适的效果。方法选取2018年5月—2020年5月于山西省第二人民医院确诊为尿毒症合并初治非肌层浸润性膀胱癌且符合入组条件的60例患者,随机分为观察组和对照组,各30例。2组患者均经尿道膀胱肿瘤电切除术后进行膀胱灌注,观察组使用羟喜树碱,质量浓度为10 mg/50 mL,10~20 mg/次;对照组使用吡柔比星,质量浓度为20 mg/50 mL,30~50 mg/次。记录2组患者术后不适发生情况,按WHO标准评估。结果与对照组相比,观察组在膀胱灌注化疗过程中不同程度的化疗相关性不良反应发生率均较低(P<0.05)。所有患者完成6个疗程的膀胱灌注化疗后,观察组肿瘤复发时间较对照组晚,但差异无统计学意义(P>0.05);观察组肿瘤复发率为6.67%,低于对照组的20.00%,但差异无统计学意义(P>0.05)。结论相较吡柔比星,采用羟喜树碱膀胱灌注可以更好地减轻尿毒症合并非肌层浸润性膀胱癌患者的术后不适,并可降低肿瘤的复发风险,值得临床推广应用。

Objective To investigate the effect of different intravesical chemotherapy drugs on relieving postoperative discomfort of uremia patients with non muscle invasive bladder cancer.Methods 60 patients with uremia and newly treated non muscle invasive bladder cancer who were diagnosed in the Second People's Hospital of Shanxi Province from May 2018 to May 2020 and met the conditions for inclusion were randomly divided into the observation group and the control group,with 30 cases in each group.Both groups of patients underwent bladder perfusion after transurethral resection of bladder tumors,while the observation group received hydroxycamptothecin at a mass concentration of 10 mg/50 mL,10-20 mg/dose.The control group used pirarubicin at a mass concentration of 20 mg/50 mL,30-50 mg/dose.Record the occurrence of postoperative discomfort in two groups of patients and evaluate according to WHO standards.Results Compared with the control group,the observation group had a lower incidence of chemotherapy related adverse reactions to varying degrees during bladder perfusion chemotherapy(P<0.05).After all patients completed 6 courses of bladder perfusion chemotherapy,the tumor recurrence time of observation group was later than that of control group,but the difference was not statistically significant(P>0.05).The recurrence rate of tumor in observation group was 6.67%,which was lower than 20.00%in control group,but the difference was not statistically significant(P>0.05).Conclusion Compared with pirarubicin,hydroxycamptothecin intravesical instillation can better alleviate postoperative discomfort in uremia patients with non muscle invasive bladder cancer,and reduce the risk of tumor recurrence,which is worthy of clinical application.