OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder c...OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder carcinoma. METHODS Fifty-eight stage T4 bladder carcinoma patients were selected. The patients were grouped to the TAI group and the TAE group. The main symptom of hemorrhage was gross hematuria. None of the patients in our study could receive trunk embolization. The infusion plan was oxaliplatin （100 mg/m2） and epirubicin （EPI 50mg/m2）. Embolization was done with coils or strips of gelatin sponge. The duration of gross hematuria was observed. Routine urinalysis and routine blood examination were performed. EORTC QLQ-C30 was used to evaluate the quality of life before and after treatment. RESULTS Gross hematuria and hematuria by light microscope in all patients were reviewed. Resolution time of gross hematuria in the TAI group was 6.7 ± 1.8 days and that in the TAE group was 3.5 ± 0.7 days. The changes in routine urianlysis, routine blood examination and EORTC QLQ-C30 are shown in Figs.l-3. Gross hematuria disappeared in both groups within 7 days after treatment, but the time for the gross hematuria to resolve in the TAE group was much less than that in TAI group （t = 2.51, P 〈 0.01）, and there were no significant differences in the 7th and 21st day between the 2 groups. On the 90th day, the number of erythrocytes in the urine was near 30, close to gross hematuria. The EORTC QLQ-C30 scores decreased after interventional therapy in both groups, which means that quality of life was increased, but there were no significant differences between the 2 groups. CONCLUSION Selective internal iliac artery infusion and selective internal iliac artery embolization are safe, and, in our study, therapeutic efficacy was satisfactory in treating unremitting gross hematuria of stage T4 bladder carcinoma in patients who could not receive trunk embolization. TAE can stop gross hematuria in the short term, but it can be used just once and the long-term therapeutic effect is not satisfactory. TAI had a therapeutic effect similar to TAE, but for a shorter duration, and TAI can be performed multiple times. TAI is one of the facultative treatments for treating gross hematuria of stage T4 bladder carcinoma.展开更多
目的:观察术前新辅助化疗治疗浸润性膀胱癌的临床疗效。方法:对27例平均年龄68岁、有全膀胱切除指征而无法耐受或不愿接受膀胱全切的浸润性膀胱癌患者行骼内动脉化疗并栓塞联合手术治疗,观察膀胱保留率、降级降期率、肿瘤复发率,Kaplan-...目的:观察术前新辅助化疗治疗浸润性膀胱癌的临床疗效。方法:对27例平均年龄68岁、有全膀胱切除指征而无法耐受或不愿接受膀胱全切的浸润性膀胱癌患者行骼内动脉化疗并栓塞联合手术治疗,观察膀胱保留率、降级降期率、肿瘤复发率,Kaplan-Meier法计算总生存率、无瘤生存率,并绘制生存曲线。结果:髂内动脉化疗、栓塞后,22例患者膀胱肿瘤缩小约81.5%,无变化5例;肿瘤临床分期降低21例(有效率77.8%),无变化6例;病理分级降低12例(降级率44.4%),分级不变15例。共24例患者得以保留膀胱,其中21例行经尿道膀胱肿瘤切除术(transurethral resection of the bladder,TURB),3例行膀胱部分切除术(膀胱保留率88.9%)。3例接受根治性膀胱全切术。术后1、2、3、5年分别复发4例(14.8%)、7例(25.9%)、11例(40.7%)、14例(51.9%)。2例随访11个月和23个月发现肿瘤远处转移后死亡,1例膀胱切口种植转移,局部切除后再发,带瘤生存,术后3年死于肿瘤进展,2例腺癌5年内死于肿瘤进展。至随访截止日期,死于术后肿瘤进展共5例。27例患者1、2、3、5年无瘤生存率分别为88.9%、73.6%、58.1%、41.4%,5年总生存率66.0%。结论:有选择地对部分浸润性膀胱癌患者施行术前髂内动脉灌注化疗、栓塞,联合手术等综合性治疗措施以保留功能性膀胱确实可行,但合理评价其在浸润性膀胱癌治疗中的应用价值尚需要进一步研究证实。展开更多
文摘OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder carcinoma. METHODS Fifty-eight stage T4 bladder carcinoma patients were selected. The patients were grouped to the TAI group and the TAE group. The main symptom of hemorrhage was gross hematuria. None of the patients in our study could receive trunk embolization. The infusion plan was oxaliplatin （100 mg/m2） and epirubicin （EPI 50mg/m2）. Embolization was done with coils or strips of gelatin sponge. The duration of gross hematuria was observed. Routine urinalysis and routine blood examination were performed. EORTC QLQ-C30 was used to evaluate the quality of life before and after treatment. RESULTS Gross hematuria and hematuria by light microscope in all patients were reviewed. Resolution time of gross hematuria in the TAI group was 6.7 ± 1.8 days and that in the TAE group was 3.5 ± 0.7 days. The changes in routine urianlysis, routine blood examination and EORTC QLQ-C30 are shown in Figs.l-3. Gross hematuria disappeared in both groups within 7 days after treatment, but the time for the gross hematuria to resolve in the TAE group was much less than that in TAI group （t = 2.51, P 〈 0.01）, and there were no significant differences in the 7th and 21st day between the 2 groups. On the 90th day, the number of erythrocytes in the urine was near 30, close to gross hematuria. The EORTC QLQ-C30 scores decreased after interventional therapy in both groups, which means that quality of life was increased, but there were no significant differences between the 2 groups. CONCLUSION Selective internal iliac artery infusion and selective internal iliac artery embolization are safe, and, in our study, therapeutic efficacy was satisfactory in treating unremitting gross hematuria of stage T4 bladder carcinoma in patients who could not receive trunk embolization. TAE can stop gross hematuria in the short term, but it can be used just once and the long-term therapeutic effect is not satisfactory. TAI had a therapeutic effect similar to TAE, but for a shorter duration, and TAI can be performed multiple times. TAI is one of the facultative treatments for treating gross hematuria of stage T4 bladder carcinoma.
文摘目的:观察术前新辅助化疗治疗浸润性膀胱癌的临床疗效。方法:对27例平均年龄68岁、有全膀胱切除指征而无法耐受或不愿接受膀胱全切的浸润性膀胱癌患者行骼内动脉化疗并栓塞联合手术治疗,观察膀胱保留率、降级降期率、肿瘤复发率,Kaplan-Meier法计算总生存率、无瘤生存率,并绘制生存曲线。结果:髂内动脉化疗、栓塞后,22例患者膀胱肿瘤缩小约81.5%,无变化5例;肿瘤临床分期降低21例(有效率77.8%),无变化6例;病理分级降低12例(降级率44.4%),分级不变15例。共24例患者得以保留膀胱,其中21例行经尿道膀胱肿瘤切除术(transurethral resection of the bladder,TURB),3例行膀胱部分切除术(膀胱保留率88.9%)。3例接受根治性膀胱全切术。术后1、2、3、5年分别复发4例(14.8%)、7例(25.9%)、11例(40.7%)、14例(51.9%)。2例随访11个月和23个月发现肿瘤远处转移后死亡,1例膀胱切口种植转移,局部切除后再发,带瘤生存,术后3年死于肿瘤进展,2例腺癌5年内死于肿瘤进展。至随访截止日期,死于术后肿瘤进展共5例。27例患者1、2、3、5年无瘤生存率分别为88.9%、73.6%、58.1%、41.4%,5年总生存率66.0%。结论:有选择地对部分浸润性膀胱癌患者施行术前髂内动脉灌注化疗、栓塞,联合手术等综合性治疗措施以保留功能性膀胱确实可行,但合理评价其在浸润性膀胱癌治疗中的应用价值尚需要进一步研究证实。
