保留膀胱髂内动脉化疗治疗膀胱癌(附38例报告)

目的：提高膀胱癌的治疗效果，尽可能保留有功能的膀胱。方法总结38例不同分期、分级膀胱癌患者的临床资料，分3组，T1 12例为第1组，行经尿道膀胱肿瘤切除术（TURBt)和髂内动脉化疗及膀胱灌注化疗；T2 14例为第2组，行膀胱部分切除，髂内动脉化疗及膀胱灌注化疗；T312例为第3组，行姑息性TURBt和髂内动脉化疗，化疗后行内动脉栓塞。结果38例中33例保留了膀胱。38例术后随访2－15。第1组中10例保留膀胱且存活至；4例多次复发者反复行TURBt，其中2例最终行全膀胱切除加淋巴清扫未发现浸润加深和转移。第2组中1例2年后死于淋巴转移，1例疗后出现肾衰行血透治疗，共13例保留膀胱，均存活至今。第3组中8例为高危病淋巴转移，1例化疗后出现肾衰行血,人13例保留膀胱，均存活至今。第3组中8组为危危病淋巴转移。1例化疗后出现肾衰行血透治疗；共13例保留膀胱，均存活至今。第3组中8例为高危病人，其中2例末坚持治疗者于2－3年内死亡；3例肿瘤消失。多次随机活检均未找到肿瘤细胞；7例肿缩小，其中3例行膀胱部分切除术，病理分期有所好转，余4例血尿控制，膀胱容量增加，一般情况改善；共10例保留膀胱，平均存活58个月，结论：保留有功能性的膀胱手术加髂内动脉藻注化疗为治疗膀胱癌有效方法之一。

A study of the bladder function after internaliliac artery chemotherapy for urinary bladder carcinoma (report of 38 cases)

Objective To study the bladder function after internal iliacartery chemotherapy for bladder carcinoma.Methods Internal iliac artery chemotherapy was undertaken for 38 cases of bladder carcinoma comprehensively treated by TURBt,partial cystectomy or paliative TURBt.12 were T1 carcinoma,14 T2 and 12 T3.Results The urinary bladder has been preserved in 33 patients.Of the 12 T1 carcinoma,repeated recurrence occurred in 4.TURBt was undertaken on each occasion whereas total cystectomy was finally carried out in 2 of them.The bladder has been preserved in 10 of 14 and the 10 are still alive;of 14 T2 (regional infiltrating carcinoma)patients,1 died of metastasis 2 years after surgery and another complicated by renal failure due to chemotherapy and has been on hemodialysis.The bladder has been preserved in 13 of the 14 and the 13 patients are still alive;of the 12 T3 patients,8 were high risk patients,2 of them died of the cancer 2～3 years after the operation.Tumors vanished in 3 patients with negative multiple randomized biopsy.Tumors became smaller in 7 and partial cystectomy was performed for 3 of them.Of another 4 with shrunken tumors,hematuria has been controlled,the bladder capacity increased and the general condition of the patients improved.The bladder has been preserved in 10 of the 12.The mean survival time has been 58 months.Conclusions Internal iliac artery chemotherapy is effective and useful for some bladder cancer with the bladder function preserved.