高危膀胱癌膀胱部分切除术后法玛新膀胱灌注化疗的疗效观察

目的探讨膀胱部分切除术后辅以法玛新(速溶型注射用盐酸表柔比星)膀胱内灌注化疗治疗高危膀胱癌的疗效。方法选取11例术前经尿道镜膀胱镜检查并膀胱肿瘤组织活检病理证实为膀胱癌的高危膀胱癌患者,采用膀胱部分切除术,术后行法玛新膀胱内灌注化疗。方法为:法玛新20mg 注射用水30ml膀胱内灌注化疗,灌注液膀胱内保留1h,并嘱患者定时改变体位;灌注化疗方案:1次/周,连续6周。停药6周后行尿道镜膀胱镜检查,每12周为1个治疗周期,期限为3年。以后每月同样剂量膀胱内灌注化疗,继续3年,每隔6个月行尿道镜膀胱镜检查,记录每次膀胱灌注后的不良事件。结果11例高危膀胱癌患者的治疗随访时间为12～63个月,中位时间29个月。患者对法玛新膀胱内灌注治疗均能耐受,治疗期间不良反应轻微,且可逆,无一例因出现严重并发症而退出治疗。治疗随访期间有2例患者出现肿瘤复发,1例于术后36个月在原有心脏疾病基础上突发加重而死亡。结论膀胱部分切除术后法玛新膀胱内灌注化疗对高危膀胱癌具有较好的疗效。该药物局部浓度高,全身不良反应小,效果可靠,如果治疗指征选择恰当,注意密切随访,可降低因尿流改道对患者生活质量的不良影响。

Intravesical Pharmorubicin Instillation for High-risk Bladder Cancers Following Partial Cystectomy

Objective To probe into the effects of Pharmorubicin(epirubicin hydrochlorid)instillation on high-risk bladder cancers following partial cystectomy.Methods Eleven patients,who were turned out to have high-risk bladder cancers by urethra cystoscope examinations and bladder neoplasm tissue biopsy pathology,were given chemotherapy of intravesical Pharmorubicin instillation after partial cystectomy.It was performed with 20mg Pharmorubicin in 30ml injection water,with the perfusate retained in the urinary bladders for 1 hour,and the patients were ordered to change positions regularly.The treatment programme was performed once a week,for 6 weeks,and then urethra cystoscope examinations followed 6 weeks after drug withdrawal.One treatment cycle was 12 weeks,and lasted 3 years.Afterwards,the same dosage of instillation was given for another 3 years,urethra cystoscope examinations done every 6 months,and adverse events were recorded after perfusion.Results All patients were followed up for 12-63 months,averaging 29 months.All tolerated intravesical Pharmorubicin instillation,with slight reversible adverse reactions.No one disengaged form the treatments due to serious complications.During treatment and follow-up,tumors recurred in 2 patients,and 1 died from sudden aggravation of original heart disease after 36 months of surgery.Conclusion Chemotherapy of intravesical Pharmorubicin instillation following partial cystectomy is of good effect on high-risk bladder neoplasms.Its local concentration is high,with slight systemic side effects.It is easy and reliable to use.Proper choice of treatment indications and close attention to follow-up can reduce the adverse effects on quality of life due to urinary rechannel.