The clinical use of interventional chemotherapy and intravesical instillation for preventing recurrence of superficial bladder cancer

Objective To study the therapeutic efficacy of combined interventional chemotherapy and intravesical instillation of mitomycin on preventing bladder cancers from recurring after local ablation. Methods 28 patients with superficial bladder cancers were randomized into combined interventional chemotherapy and intravesical instillation of mitomycin or intravesical instillation of mitomycin alone for preventing recurrence after local ablation. The result was assessed by x2 test. Results The patients have been followed up for 12-26 months (mean 21 months). 1 case has had tumor recurrence in the combined modality therapy group and 4 in the intravesical instillation alone group, the tumor recurrence rate being 7% (1/14) and 29% (4/14) respectively (P【0.05). Conclusion Combined use of interventional chemotherapy and intravesical instillation of mitomycin is effective in preventing superficial bladder cancer from recurring after local ablation with fewer adverse effects. The ragimen is not only reliable but

A multi-institutional retrospective study of hyperthermic plus intravesical chemotherapy versus intravesical chemotherapy treatment alone in intermediate and high risk nonmuscle-invasive bladder cancer

Objective:To compare the efficacy and safety of hyperthermic intravesical chemotherapy(HIVEC)and intravesical chemotherapy(IVEC)in patients with intermediate and high risk nonmuscle-invasive bladder cancer(NMIBC)after transurethral resection.Methods:We included 560 patients diagnosed with primary or recurrent NMIBC between April 2009 and December 2015 at 1 of 6 tertiary centers.We matched 364 intermediate or high risk cases and divided them into 2 groups:the HIVEC+IVEC group[chemohyperthermia(CHT)composed of 3 consecutive sessions followed by intravesical instillation without hyperthermia]and the IVEC group(intravesical instillation without hyperthermia).The data were recorded in the database.The primary endpoint was 2-year recurrence-free survival(RFS)in all NMIBC patients(n=364),whereas the secondary endpoints were the assessment of radical cystectomy(RC)and 5-year overall survival(OS).Results:There was a significant difference in the 2-year RFS between the two groups in all patients(n=364;HIVEC+IVEC:82.42%vs.IVEC:74.18%,P=0.038).Compared with the IVEC group,the HIVEC+IVEC group had a lower incidence of RC(P=0.0274).However,the 5-year OS was the same between the 2 groups(P=0.1434).Adverse events(AEs)occurred in 32.7%of all patients,but none of the events was serious(grades 3–4).No difference in the incidence or severity of AEs between each treatment modality was observed.Conclusions:This retrospective study showed that HIVEC+IVEC had a higher 2-year RFS and a lower incidence of RC than IVEC therapy in intermediate and high risk NMIBC patients.Both treatments were well-tolerated in a similar manner.

Long-term versus Short-term Introvesical Chemotherapy in Patients with Non-muscle-invasive Bladder Cancer:A Systematic Review and Meta-analysis of the Published Results of Randomized Clinical Trials

In order to assess the effect of long-term versus short-term intravesical chemotherapy in preventing the recurrence of patients with non-muscle-invasive bladder cancer, we searched several da- tabases with words as mesh terms and free text words to find all eligible randomized clinical trials （RCTs） for the Comparison of the two strategies of instillation durations. ＂Observed-Expected events re- search （O-E）＂ and ＂Variance （V）＂ for calculating hazard ratio （HR） were used in Revman 5.2 software recommended by Cochrane Collabration for data analysis. Sensitivity and subgroup analysis were se- lected to minish heterogeneity. GRADEpro 3.6 profile recommended by Cochrane Collabration was employed for quality assessment of analyses. Finally, 13 eligible RCTs with 4216 patients were in- eluded in this review and 16 comparisons from 13 trials were involved for analysis. The pooled analysis revealed no significant difference between long-term and short-term duration [HR=0.99, 95% CI （0.89, 1.11）, P=-0.89]. Within the subgroup analysis, patients benefited from long-term instillations with a start regimen of one immediate instillation [HR=0.83, 95% CI （0.69, 1.00）, P=-0.05]. But patients were not suitable to receive long-term instillations with epirubicin （EPI） [HR=1.01, 95% CI （0.91, 1.13）, P=0.78] The progression rate was not reduced after long-term instillations [HR=0.96, 95% CI （0.66, 1.39）, P=0.82]. From our results, patients should not receive introvesical chemotherapy more than half a year. In contrast, patients with one immediate instillation are preferred to have a long-term duration at least one year. Long-term instillations can not reduce the progression rate.

Intravesical chemotherapy synergize with an immune adjuvant by a thermo-sensitive hydrogel system for bladder cancer

Surgical resection remains the prefer option for bladder cancer treatment.However,the effectiveness of surgery is usually limited for the high recurrence rate and poor prognosis.Consequently,intravesical chemotherapy synergize with immunotherapy in situ is an attractive way to improve therapeutic effect.Herein,a combined strategy based on thermo-sensitive PLEL hydrogel drug delivery system was developed.GEM loaded PLEL hydrogel was intravesical instilled to kill tumor cells directly,then PLEL hydrogel incorporated with CpG was injected into both groins subcutaneously to promote immune responses synergize with GEM.The results demonstrated that drug loaded PLEL hydrogel had a sol-gel phase transition behavior in response to physiological temperature and presented sustained drug release,and the PLEL-assisted combination therapy could have better tumor suppression effect and stronger immunostimulating effect in vivo.Hence,this combined treatment with PLEL hydrogel system has great potential and suggests a clinically-relevant and valuable option for bladder cancer.

Folic Acid Modified Polymeric Micelles for Intravesical Instilled Chemotherapy

In this study, a targeting micellar drug delivery system was developed for intravesical instilled chemotherapy of bladder cancer. The amphiphilic diblock copolymer poly（？-caprolactone）-block-poly（ethylene glycol）（PCL-b-PEO） with functional amino group（NH2） at the end of PEO block was synthesized. Then the copolymer was conjugated with folic acid（FA） and fluorescein isothiocyannate（FITC） via the PEO-NH2 terminus, and then assembled into micelles with the target moiety and fluorescence labeling. In addition, drug loaded micelles were also fabricated with anticancer drug doxorubicin（DOX） encapsulated in the hydrophobic core. The micelles were characterized in terms of size, drug loaded efficiency and critical micellization concentration（CMC） by means of DLS, UV and fluorescence spectra. In vitro cellular uptake and cytotoxicity studies showed that FA modified PCL-b-PEO-FA micelles have a greater targeting efficiency to human bladder cancer cell（T-24 cell） compared to PCL-b-PEO-NH2 micelles due to the conjugation of FA on the surface, while no targeting effect to normal tissue originated human embryonic kidney 293（HEK-293） cells was observed, enabling the micelles a promising drug carrier for intravesical instilled chemotherapy of bladder cancer.

Pilot study of intravesical instillation of two new generation anthracycline antibiotics in prevention of superficial bladder cancer recurrence

Background Superficial bladder cancer accounts for 60%-70% of all bladder cancer cases in China, when treatment consists of only transurethral resection of the bladder tumor （TUR-BT）, recurrence and progresses in the bladder are observed in some patients. There are numerous reports of trials of intravesical instillation of anticancer agents with the objective of lowering this recurrence rate. The aim of this study was to compare the prophylactic efficacy and safety of epirubicin （EPI）, pirarubicin （THP） and hydroxycamptothecin （HCPT） in superficial bladder cancer.Methods This study enrolled a total of 189 patients who had been diagnosed with superficial bladder cancer during the period from 2004 through 2007 at Beijing Friendship Hospital. All patients were randomly allocated to one of three treatment groups. Patients in group A received 29 doses of EPI 30 mg/30 ml, patients in group B received 29 doses of THP 30 mg/30 ml, and patients in group C received 29 doses of HCPT 30 mg/30 ml, over a period of 24 months.Results The recurrence-free rate in the 2 anthracycline treatment groups （A and B） were significantly better than that of the HCPT treatment group. In the safety evaluation, the incidences of pollakiuria, pain on urination, dysuria, hematuria,and contracted bladder were not significantly different between groups A and B, but some were significantly higher in groups A and B than that in group C.Conclusion The efficacy of EPI and THP was significantly better than HCPT in the prevention of bladder cancer recurrence.

Impact of surgery and epirubicin intravesical chemotherapy on peripheral blood dendritic cell subsets in patients with superficial urothelial carcinoma of the bladder

Background Superficial urothelial carcinoma （SUC） of the bladder is a common urinary tract tumor in China. There is a high recurrence rate of this tumor even after surgery and intravesical instillation. Previous reports have described a suppression of the immune system in cancer patients. Dendritic cells （DCs） play a pivotal role in the induction of an effective antitumor immune response. The aim of this study was to investigate the effects of surgery and epirubicin intravesical chemotherapy （IC） on peripheral blood DCs in subsets of patients with bladder SUC. Methods A total of 66 SUC patients and 38 healthy controls were enrolled in this study. All the patients had undergone transurethral resection （TUR） of their cancer and adjunctive IC after tumor removal. The patients were divided into a non-recurrence group （n=40） and a recurrence group （n=26） based on the presence or absence of tumor recurrence. Blood samples were taken preoperatively （PreOP）, on postoperative days （POD） 1 and 7, and at postoperative month （POM） 3. Flow cytometric analysis was used for the determination and quantitation of the surface markers CD80 and CD86 in circulating DC subsets. Results The preoperative percentages of myeloid dendritic cells （mDCs） and expression of CD80 and CD86 were impaired in SUC patients compared to healthy controls （P 〈0.05）. The percentages of mDCs and these surface markers decreased significantly on POD 1 and increased on POD 7, remaining higher than the preoperative values in POM 3 （P 〈0.05）. The percentages of mDCs, and CD80 and CD86 in the non-recurrence group on PreOP, POD 7, and POM 3 were higher than those in recurrence group. Conclusions Surgical removal of SUC and adjunctive IC were associated with improved circulating mDC counts and function. Persistent depression of mDC counts and function after treatment in recurrence patients indicated lower antitumor immunity that may lead to tumor recurrence.

Intravesical Instillation in Pure Line LEW Rats and Nude Mice

In order to study bladder intravesical instillation methods in pure line LEW rats and nude mice, female LEW rats and nude mice aged 2 to 4 weeks were sacrificed. Their urethra and bladder were observed under anatomical microscopy. A trochar was prepared according to the outline and an- gle of the urethra. Ink was poured into female rats and nude mice bladder though urethra. Filling and staining of bladder were observed and evaluated under anatomical microscopy. Status and urethral injury of rats and mice were observed. The results showed that urethra anatomic structure of rats and nude mice was different from that of human urethra. When bladder was filled with ink and became blue, liquid was not seen to leak out. The success rate of intubation was high (100%). Living activi- ties of animals weren’t influenced by intravesical instillation. It was concluded that bladder irrigation might be a kind of valid and utilizable method in pure line rat and nude mouse empirical study. The model may be a more effective tool for study of bladder tumor.

单次灌注化疗后膀胱持续生理盐水冲洗或增加中低风险非肌层浸润性膀胱癌进展风险

目的探究行经尿道膀胱肿瘤切除术(TURBT)的中低风险非肌层浸润性膀胱癌(NMIBC)患者单次即刻膀胱灌注化疗(SIIC)后膀胱持续生理盐水冲洗(CSBI)的治疗效果。方法回顾性分析2004年1月—2019年12月于北京大学人民医院泌尿外科行TURBT的211例中低风险NMIBC患者的临床资料,根据患者SIIC后是否进行CSBI分为CSBI组和无CSBI组,比较两组患者的复发率、进展率、无复发生存率和无进展生存率。通过Cox单因素及多因素回归分析探究CSBI是否为患者肿瘤复发和进展的危险因素。结果两组患者的基线资料、复发率和进展率比较,差异均无统计学意义(P>0.05)。两组患者无复发生存率比较无明显差异,而CSBI组无进展生存率更低(χ^(2)=8.270,P=0.004)。在多因素Cox回归分析中,糖尿病(HR:2.240,95%CI:1.066~4.704,P=0.033)和多发肿瘤(HR:3.060,95%CI:1.639~5.711,P<0.001)是中低风险NMIBC患者肿瘤复发的独立危险因素,CSBI(HR:7.914,95%CI:1.710~36.632,P=0.008)是肿瘤进展的独立危险因素。结论SIIC后CSBI可能会增加中低风险NMIBC患者的进展风险,但该结论仍需要更大样本量进行验证。

Swallowing Difficulties,Oral Symptoms,and Nutrition in Long-Term Care Elderly Residents-A Secondary Publication

Oral health is often impaired in people living in residential care.In older people,poor oral health is associated with functional deficits,multiple sclerosis,and memory disorders.Keeping one’s teeth healthy throughout life would promote both oral health and general health.Biting and swallowing problems in older people are also linked to oral health,limiting eating activities and requiring diet changes to softer foods that are easy to chew and swallow.This may limit dietary diversity and adequate nutrient intake.Although eating-related chewing and swallowing problems are common in institutionalized residents,they are often addressed too late,when the resident is already malnourished.Nutrition in nursing and retirement homes has been the subject of various studies since the 2000s.However,studies on swallowing and chewing difficulties are scarce and their link to adequate nutrient intake has received lesser attention[6,7].

临床护理路径在膀胱癌患者术后膀胱灌注化疗中的应用效果

目的探讨临床护理路径在规范膀胱癌患者术后膀胱灌注化疗中的应用效果。方法选择于2022年1月至2023年12月入住江苏省太仓市第一人民医院的非肌层浸润性膀胱癌术后行膀胱灌注化疗的60例患者作为研究对象,采用随机数字表法将患者分为常规组和路径组,每组30例。常规组予以常规护理,路径组在常规组基础上采用临床护理路径,责任护士根据临床护理路径对患者进行灌注前、灌注中、灌注后宣教,指导患者参与到灌注自我安全管理中。比较两组患者的灌注知识掌握情况、依从性、化疗药物保留时间以及灌注后不良反应的发生率。结果路径组患者灌注前、灌注中、灌注后知识掌握率分别为46.67%(14/30)、63.33%(19/30)、86.67%(26/30),均高于常规组的13.33%(4/30)、33.33%(10/30)、63.33%(19/30),差异有统计学意义(P<0.05)。路径组患者的依从性高于常规组(P<0.05)。路径组患者化疗药物保留时间达标率85.33%(25/30),高于常规组的60.00%(18/30),差异有统计学意义(P<0.05)。护理后,常规组不良反应发生率为30.00%(9/30),路径组为10.00%(3/30),两组比较差异无统计学意义(P>0.05)。结论采用临床护理路径对膀胱癌术后行膀胱灌注患者进行护理干预,能规范临床操作,提高患者对灌注知识的掌握度、提升依从性以延长化疗药物保留时间,减少灌注后不良反应的发生。

高危非肌层浸润性膀胱癌术后行膀胱热灌注化疗和卡介苗灌注治疗的对比研究

目的:探讨膀胱热灌注化疗和卡介苗(BCG)膀胱灌注预防高危非肌层浸润性膀胱癌患者术后复发的安全性和有效性。方法:回顾性分析2019年8月—2021年8月在新乡医学院第一附属医院行经尿道膀胱肿瘤电切术,且术后行吉西他滨膀胱热灌注化疗(HIVEC-GEM)或BCG膀胱灌注的高危非肌层浸润性膀胱癌患者资料共74例,其中38例行HIVEC-GEM膀胱灌注(HIVEC-GEM组),36例行BCG膀胱灌注(BCG组),比较两组术后肿瘤复发率和进展率以及不良反应发生率。结果:两组术后6个月的复发率(5.26%vs.2.78%,χ^(2)=0.002)和进展率(5.26%vs.2.78%,χ^(2)=0.002)、术后12个月的复发率(13.16%vs.8.33%,χ^(2)=0.086)和进展率(10.53%vs.8.33%,χ^(2)=0.006)以及术后24个月的复发率(18.42%vs.13.89%,χ^(2)=0.279)和进展率(13.16%vs.11.11%,χ^(2)=0.007)差异均无统计学意义(均P>0.05),多种不良反应发生率之间的比较也无统计学意义(均P>0.05)。结论:HIVEC-GEM的疗效和安全性与BCG膀胱灌注相当。

吉西他滨膀胱灌注化疗在非肌层浸润性膀胱癌术后患者中的应用效果

目的探讨吉西他滨膀胱灌注化疗在非肌层浸润性膀胱癌术后患者中的应用效果。方法根据治疗方法的不同将120例非肌层浸润性膀胱癌患者分为对照组和观察组,每组60例。所有患者均进行手术治疗,对照组患者术后给予吡柔比星膀胱灌注化疗,观察组患者术后给予吉西他滨膀胱灌注化疗。比较两组患者的临床疗效、肿瘤标志物[血清癌胚抗原(CEA)、尿纤维蛋白原降解产物(FDP)]水平、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]及不良反应发生情况。结果观察组患者的疾病控制率为88.33%,明显高于对照组患者的68.33%,差异有统计学意义(P﹤0.01)。治疗后,两组患者血清CEA、尿FDP水平均低于本组治疗前,观察组患者血清CEA、尿FDP水平均低于对照组,差异均有统计学意义(P﹤0.05)。治疗后,两组患者躯体功能、角色功能、社会功能、总体健康评分均高于本组治疗前,观察组患者躯体功能、角色功能、社会功能、总体健康评分均高于对照组,差异均有统计学意义(P﹤0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P﹥0.05)。结论吉西他滨膀胱灌注化疗可提高非肌层浸润性膀胱癌术后患者的临床疗效和生活质量,降低肿瘤标志物水平,且安全性良好。

术前血清FOXO1、FABP4水平与非肌层浸润性膀胱癌患者经尿道膀胱肿瘤切除术后灌注治疗疗效的相关性分析

目的:探讨术前血清叉头框蛋白O1(Fork head box protein O1,FoxO1)和脂肪酸转运蛋白4(fatty acid-binding protein 4,FABP4)与非肌层浸润性膀胱癌(Non-muscle invasive bladder cancer,NMIBC)患者灌注治疗疗效的关系。方法:选取2021年1月至2022年10月期间本院收治的68例NMIBC患者作为研究对象。所有患者进行经尿道膀胱肿瘤切除术(Transurethral resection of bladder tumor,TURBT)治疗,患者术后给予表柔比星膀胱灌注。随访12 m,根据最终的病理结果,将患者分为复发组和未复发组。检测对比两组术前血清FOXO1水平和FABP4水平。分析术前血清FABP4水平与TURBT术后膀胱灌注疗效的相关性及诊断价值。结果:68例患者TURBT术后给予表柔比星膀胱灌注,复发率22.1%。复发组术前血清FOXO1水平与未复发组无明显差异(P>0.05);复发组术前血清FABP4水平显著高于未复发组(P<0.05)。以术前血清FABP4水平预测TURBT术后给予表柔比星膀胱灌注治疗后复发的AUC=0.7052。结论:术前血清高FABP4水平提示TURBT术后给予表柔比星膀胱灌注治疗易复发,其用来预测表柔比星膀胱灌注治疗效果有较高价值。

TUR-Bt术后膀胱内灌注吡柔比星预防复发的临床观察

目的：探讨吡柔比星（THP）膀胱内灌注化疗预防浅表性膀胱癌TUR－Bt术后的效果和安全性。方法：选择44例TUR－Bt术后并有随访结果的病例，术后定期应用THP 30mg／30ml 1次／周，连续8周以后1次／月，连续8个月。膀胱内灌注化疗，每次膀胱内保留30分钟，根据随访结果对其疗效进行评价。结果：44例TUR－Bt术后患者均定期随访6～l2个月，无肿瘤复发，6例膀胱粘膜活检阳性的病例，也未见明确肿瘤生长。结论：吡柔比星对浅表性膀胱癌有明显的治疗和预防复发的作用，对膀胱内未见明确肿瘤，而膀胱粘膜活检阳性的病例亦有明显的治疗作用。

透明质酸钠膀胱灌注治疗间质性膀胱炎的研究

目的探讨问质性膀胱炎(Interstitial cystitis,IC)新的治疗方法。方法29例IC患者随机分为A、B两组,A组(治疗组)15例,B组(对照组)14例。A组2％利多卡因20ml膀胱灌注10min后,0.2％透明质酸钠100 ml+地塞米松10 mg膀胱灌注,每周1次,共6周。B组用1:5000呋喃西林溶液替代0.2％透明质酸钠溶液,方法类同A组,观察两组用药后临床症状评分及治疗前后尿动力学指标。结果两组用药后临床症状评分比较差异具有显著性意义(P<0.01)。A组治疗前后尿动力学指标比较差异有显著意义(P<0.01),13例患者临床症状消失,10例患者膀胱容量明显增加。B组用药前后尿动力学指标比较差异无显著意义(P>0.05),4例患者临床症状消失,膀胱容量无明显改善。结论透明质酸钠膀胱灌注治疗间质性膀胱炎是一种有效、简便、易行的新治疗途径。

羟基喜树碱术后即刻灌注联合维持灌注预防非浸润性膀胱癌复发的长期疗效分析

目的:总结大剂量羟基喜树碱即刻灌注联合维持灌注预防非肌层浸润性膀胱癌术后复发的疗效。方法:回顾性分析了167例中、高危非肌层浸润性膀胱尿路上皮癌患者的临床资料.男性116例,女性51例,平均年龄51岁。所有患者均经病理诊断证实,分期为Ta71例、T_196例,分级为G_166例、G_250例、G_351例。患者行经尿道膀胱肿瘤电切术后即刻膀胱内灌注羟基喜树碱40mg,保留20～30 min,术后1w开始羟基喜树碱维持灌注,40 mg/次,1次/w×8次,以后1次/月×10次,每次维持2 h。结果:155例患者获得随访,平均随访期92(72～112)个月。患者1、2和5年肿瘤复发率分别为23.2%、31.6%和41.3%。治疗的长期预后因素包括肿瘤的分级、分期、数目和大小。本组中膀胱Ⅰ、Ⅱ和Ⅲ度不良反应的发生率为13.5%、3.2%和1.9%,未见Ⅳ度不良反应。全身不良反应仅见Ⅰ度不良反应,发生率为1.3%。结论:大剂量羟基喜树碱即刻灌注联合维持灌注预防膀胱癌术后复发的长期疗效较为满意,不良反应发生率低,患者多能良好耐受治疗。

膀胱癌术后患者恐惧疾病进展现状及影响因素研究

目的了解膀胱癌术后膀胱灌注化疗患者恐惧疾病进展现状并分析影响因素,为心理护理提供参考。方法采用一般情况调查表、恐惧疾病进展简化量表、简易疾病感知问卷对110例膀胱癌术后首次膀胱灌注化疗患者进行问卷调查。结果患者恐惧疾病进展总分(25.31±5.35)分,7.27%的患者出现心理功能失调;多元回归分析显示,疾病感知、肿瘤复发、肿瘤组织学分级、性别、年龄是膀胱癌术后膀胱灌注化疗患者恐惧疾病进展的影响因素(P<0.05,P<0.01)。结论膀胱癌术后膀胱灌注化疗患者存在疾病进展恐惧,需重点关注女性、复发及高组织学分级患者,可通过改善疾病感知以降低患者的恐惧疾病进展水平。

TURBT术后吡柔比星膀胱灌注预防肿瘤复发的疗效分析

[目的]评价吡柔比星（THP）膀胱灌注预防膀胱肿瘤TURBT术后复发的疗效和安全性。[方法]1999年11月-2003年10月，膀胱肿瘤TURBT术后患者63例，术后接受THP30mg膀胱灌注治疗，随访12-53个月。[结果]膀胱癌TURBT术后THP膀胱灌注，术后1年未复发率89．8％，术后2年未复发率83．1％，术后3年未复发率76．3％；膀胱灌注THP副反应发生率为28．57％。[结论]应用THP30mg／50mL（600μg／mL），TURBT术后尽早膀胱灌注，膀胱内保留30min，采用为期1年的短期疗程，对于预防膀胱肿瘤TURBT术后复发有较好的疗效。

单次与多次膀胱灌注方案对原发性上尿路尿路上皮癌术后预后的影响

目的:探讨单次与多次膀胱灌注方案对上尿路尿路上皮癌(UUT-UC)术后患者的疗效和安全性。方法:收集本院2010年6月至2016年7月收治的原发性上尿路尿路上皮癌术后患者63例,根据化疗方案分为单次膀胱灌注组(SIG)和多次膀胱灌注组(RIG)。比较两组无进展生存期(PFS)、总生存期(OS)和近期毒副反应。结果:全组随访5~60个月,中位随访36.4个月。SIG和RIG 3年、5年OS分别为65.5%、51.7%和67.6%、52.9%,二者比较差异无统计学意义(P>0.05);3年、5年PFS分别为79.3%、72.4%和85.3%、76.5%,两组PFS差异有统计学意义(P<0.05)。两组不良反应主要以1~2级的血液学毒性反应和消化道反应为主。RIG在血液学毒性方面发生率明显高于SIG,差异有统计学意义(P<0.05)。消化道反应及膀胱痉挛、膀胱炎方面,RIG高于SIG,两组比较差异有统计学意义(P<0.05)。肝、肾功能损害及发热方面,两组比较差异无统计学意义(P>0.05)。结论:吡柔比星在UUT-UC术后膀胱预防灌注化疗临床是安全有效的,多次灌注化疗较单次可减少膀胱肿瘤复发率,但不能提高总生存时间。但多次灌注方案引起更严重的消化道反应和血液学毒性反应。