摘要
目的探讨根治性经尿道膀胱肿瘤电切术（TURBt）加化疗治疗肌层浸润性膀胱癌的临床疗效。方法术前经CT及膀胱镜检查确诊为肌层浸润性膀胱癌不能耐受或拒绝行根治性膀胱切除术的患者32例，肿瘤最大直径1～5cm，平均3cm。临床分期：T2a期20例，T2b期12例。病理分级：G2 13例，G3 19例。采用根治性TURBt切除肿瘤至膀胱壁外脂肪层，范围至肿瘤基底部周围1—2cm正常膀胱黏膜。术后常规行多西他赛75mg／m2＋奥沙利铂130mg／m2静脉化疗，羟喜树碱20mg＋生理盐水20m1膀胱灌注治疗。定期复查膀胱镜检查观察肿瘤复发情况。结果32例手术顺利。手术时间15—70min，平均55min；出血量10～150ml，平均33ml；术中术后未发生较严重并发症。术后病理报告均为移行细胞癌。32例化疗后出现骨髓抑制引起白细胞降低8例，肌肉注射重组人粒细胞集落刺激因子后好转；出现低热、轻微恶心、头痛3例，休息2～3d后好转。术后随访3—60个月，平均28个月。术后1年复发率9．4％（3／32），2年复发率12．5％（4／32）。复发病例中T2a期4例，T2b期3例。死亡12例，5例死于膀胱癌转移。无瘤存活20例。结论根治性TURBt加化疗可作为经过选择的肌层浸润性膀胱癌的一种有效的治疗方法。
Objective To evaluate the efficacy of radical transurethral bladder tumor resection plus chemotherapy for the treatment of muscle-invasive bladder cancer. Methods Thirty-two patients, who were diagnosed muscle-invasive bladder cancer by preoperative CT and cystoseopy and not tolerating or rejecting radical eystectomy were treated by transurethral resection of bladder tumor （TURBt）. The maximum diameter of tumor ranged from 1 - 5 era, 3 em on average. After conventional intravenous chemotherapy （docetaxel 75 mg/m2 ＋ oxaliplatin 130 mg/m2 ） , and given intravenous therapy （ HCPT 20 mg＋ 20 ml saline）. Regular cystoscopy was used to monitor tumor recurrence. The examination was performed quarterly in the first 2 years post operation, twice a year since the third year. Results The tumors of 32 cases were reseeted completely. Operative time were 15 -70 min, the blood loss was 10 -150 ml, without serious complications during the operation. Pathological report showed 32 cases of transitional cell carcinoma. Clinical stages were T2a 20 cases, T2b 12 cases. Pathological grade were G2 13 cases, G3 19 cases. There was no bone marrow suppression, anemia or other severe complications was seen in 32 cases that received chemotherapy. 3 of which manifested as low fever, mild nausea, and headache, respectively, having a rest 2 to 3 days the symp- toms disappeared. 32 patients were followed up for 3 - 60 months, a mean of 28 months. After 1 year the recurrence rate was 9.4% （3/32） , after 2 years was 12.5% （4/32）. The TNM stage of these recurrence cases were 4 cases with T2a and 3 cases with T2b. 12 patients died, 5 patients died of bladder cancer metastasis. Other 20 patients were survival with no recurrence. Conclusion Radical TURBt plus chemotherapy could be a treatment for the selected patients with muscle invasive bladder cancer.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第3期215-218,共4页
Chinese Journal of Urology
关键词
膀胱肿瘤
经尿道电切术
化疗
灌注
局部
Bladder neoplasms
Transurethral resection
Chemotherapy
Perfusion, regional
