两种膀胱灌注方法在浅表性膀胱癌TUR-BT术后的疗效比较

目的 比较吡柔比星（THP）、羟基喜树碱（HCPT）交替疗法及其联合疗法在浅表性膀胱癌术后治疗的疗效.方法 收集2003年5月至2009年5月来本院诊治的113例浅表性膀胱肿瘤患者的临床资料,均行经尿道膀胱肿瘤切除术（TUR-BT）,术后均应用THP＋ HCPT交替法或THP＋ HCPT联合法膀胱内灌注治疗,随访3年,观测两组在3、6、9、12、18、24、36个月时的肿瘤复发率及灌注期间的不良反应发生率.结果 THP＋ HCPT联合组、THP＋ HCPT交替组术后3、6、9、12、18、24、36个月患者的复发率分别为：3.5％、0.0％,8.8％、1.8％,14.0％、1.8％,15.8％、3.6％,19.3％、5.4％,22.8％、8.9％,28.1％、12.5％. THP＋ HCPT交替组的术后复发率低于THP＋ HCPT联合组,术后9个月后两组间的差异均有统计学意义（P＜0.05）.两组尿路刺激症状发生率分别为43.8％、25.0％（P＜0.05）,血尿发生率分别为14.0％、1.8％（P＜0.05）,肝功能损害发生率分别为3.6％、1.8％（P＞0.05）,肾功能损害的发生率分别为5.3％、1.8％（P＞0.05）.结论 浅表膀胱癌在行TUR-BT后,膀胱内灌注THP＋ HCPT交替法预防膀胱癌术后复发疗效确定,较THP＋HCPT联合法复发率低,毒副作用亦低,可能具备一定的临床推广价值.

Comparison of two kinds of bladder perfusion method curative effect in superficial bladder cancer after TUR-BT operation

Objectives Comparison the alternative therapy and combined therapy effects of pirarubicin hydrochloride（THP） and hydroxy camptothecin （HCPT） in the treatment of superficial bladder cancer after operation.Methods The clinical data of 113 cases of superficial bladder tumor were collected in 2003 May to 2009 May in our hospital,which were treated with transurethral resection of bladder tumor （TUR-BT）,postoperative application of THP ＋ HCPT alternating method or a combination of THP ＋ HCPT method in bladder perfusion therapy.all of them are follow-up of 3 years,the recurrence rate of the tumors was observed in 3 months 、6 months、9 months、12 months 、18 months、24 months、36 months and the incidence of adverse reaction was observed during the reperfusion period.Results After 3 months 、6 months、9 months、12 months、18 months 、24 months 、36 months the recurrent rates of the THP ＋ HCPT group and the THP ＋ HCPT alternating group were,3.5%、0% 、8.8%、1.8%,14%、1.8% 、15.8%、3.6% 、19.3%、5.4%,22.8%、8.9% 、28.1%、12.5%,respectively.The recurrence rate of THP ＋ HCPT alternating group was lower than the THP ＋ HCPT group,the differences between the two groups was statistically significant （P 〈 0.05） after 9 months of bladder perfusion therapy.The occurrence rate of urinary irritation symptoms in the Two groups was 43.8% and 25% function damage rate was observed in 3.6% and 1.8%,respectively（P 〉 0.05）,renal function damage rate was 5.3% and 1.8%,respectively （P 〉 0.05）.Conclusions Superficial bladder cancer line TUR-BT,intravesical instillation of THP ＋ HCPT alternating method can prevent the recurrence after resection of bladder cancer,compared with combined THP ＋ HCPT method that has lower recurrence rate and side effects,and it is recommendable for clinic.