AgNORs数量的变化在动脉化疗配合手术治疗膀胱癌中的意义

The change of AgNORs numbers in arterial chemotherapy followed by open surgery to treat the transitional cell carcinoma of bladder

目的通过AgNORs染色分析技术检验膀胱癌动脉化疗前、后Ag,NORs均值的变化,评价膀胱癌术前行动脉化疗的意义.方法25例膀胱癌患者,经术前膀胱镜活检证实为膀胱移行细胞癌(TCC),其中Ⅱ级8例,Ⅱ～Ⅲ级4例,Ⅲ级8例,Ⅲ～Ⅳ级1例,Ⅳ级4例.经腹壁下动脉插导管至髂总动脉行ADM+CDDP联合化疗1～2个疗程后行膀胱部分切除术.将膀胱镜及手术所取之病理标本经Ag,NORs技术染色,计数其细胞核内平均AgNORs数量,进行配对t检验,并对患者进行术后随访.结果配对t值为5.230,而t(0.01)24=2.787,t＞t',所以P＜0.01,化疗前后膀胱癌组织AgNORs均值间有极显著差异.25例患者无明显并发症.经随访3年复发率为8.33%,5年复发率为12.50%,5年存活率为87.50%.结论术前经动脉化疗可降低膀胱癌的恶性程度,降低复发率,提高生存率,其效果优于单纯膀胱部分切除术+术中黏膜下注射抗癌药物,对恶性度高的膀胱癌是一种理想的治疗方法.

Objective Testing the change of the numbers in cancer nucleolar AgNORs before and after arterial chemotherapy to assess the significance of preoperational chemotherapy in transitional cell carcinoma of bladder. Methods 25 cases of patients were selected, who were all diagnosed of bladder TCC by preoperational cystoscopic biopsy. Of the 25 cases, 8 cases were grade Ⅱ , 4 cases were grade Ⅱ- Ⅲ , 8 cases were grade Ⅲ, 1 cases were grade Ⅲ-Ⅳ , 4 cases were grade Ⅳ . A silica plastic tube was incubated into common iliac artery viainferior epigastric artery before open surgery. Infused ADM and cisplatin for 1-2 course, then performed partial cystoctomy. The pathologic tissues which obtained by cystoscope and operation were stained by AgNORs techniques, counted the mean AgNORs particle numbers, did paired test, then did the follow-up survey. Results paired data t=5.230, while t0.01(24) =2.787, t>t',P<0.01, thus, there was significant difference between pre-and post-operational tissues. All the 25 cases of patients had no obvious complications. The 3-year recurrence rate was 8.33%, 5-year recurrence rate was 12.5%, while 5-year survival rate was 87.5%. Concl-usion Pelvic arterial chemotherapy followed by open surgery could decrease the malignancy and the recurrence rate , increase the survival rate of bladder cancer, which was an ideal method to treat higher grade malignant bladder cancer. The effect was better than that of simple partial cystectomy followed by intravescical chemotherapy.