根治性经尿道膀胱肿瘤治疗肌层浸润性膀胱癌的疗效观察

目的：探讨化疗联合根治性经尿道膀胱肿瘤电切术（TURBt）治疗肌层浸润性膀胱癌的疗效及安全性。方法：选取从2009年11月～2012年11月辅助检查确诊的肌层浸润性膀胱癌患者70例,为患者应用化疗联合根治性经尿道膀胱肿瘤电切术治疗。肿瘤的最大直径大小平均为2．7±0．2om（1～5cm）。临床上分期分为：T2a期35例,T2b期35例,病理上分期为：G2：50例,G3：20例。为患者签订知情同意书后。首先为患者行根治性经尿道膀胱肿瘤电切术,术后为患者联合应用多西他赛75mg／m。＋奥沙利铂130mg/m^2静脉化疗,羟喜树碱20mg＋生理盐水20ml膀胱灌注治疗。为患者进行定期的随诊观察,检测治疗的效果。结果：术中平均出血量为37±10．2（10～170）ml,平均手术时间为：59±20．1（20～80）min。所有患者术中及术后均未见严重的手术并发症。病理诊断确诊所有患者均未移行性细胞癌。有20例患者出现化疗的副作用,其中11例患者出现骨髓抑制引起白细胞降低,9例患者出现头痛低热及轻微恶心,经对症治疗后均行好转。对所有患者进行随访平均为39个月（12～50个月）。其中12个月时有5例患者复发,24个月时有9例患者复发。在所有随诊患者中共20例患者死亡,无瘤存活患者为50例。结论：化疗联合根治性膀胱肿瘤电切术是一种安全且疗效显著地治疗肌层浸润性膀胱癌手术方法。     

髂内动脉化疗栓塞在极高危非肌层浸润性膀胱癌经尿道电切术后的应用及价值

【摘要】 目的 极高危非肌层浸润性膀胱癌具有很高的复发和进展风险。明确双侧髂内动脉化疗栓塞术（IAC）经尿道电切术后辅助措施的价值。方法 回顾性分析2015年1月至2017年12月收治的该类患者38例,均接受经尿道膀胱肿瘤电切术及术后规律膀胱灌注治疗（卡介苗或表柔吡星/吡柔吡星）,根据是否接受IAC分为IAC组及对照组。IAC组在电切术后2周内接受第1疗程IAC,再间隔3～4周行第2疗程IAC,化疗方案:顺铂60 mg/m2,吡柔比星25 mg/m2。术后随访指标包括无复发生存时间、随访期间进展率及切除膀胱率等。 结果 IAC组12例,对照组26例,平均随访时间 （30.1±12.4）个月。IAC组与对照组在主要观察指标上的比较如下:无复发生存时间 （20.3±14.1）个月比 （8.9±7.2）个月,（P=0.002）,1年无复发生存率66.7%比26.9%,（P=0.02）,2年无复发生存率33.3%比7.7%,（P=0.07）,随访期间进展率33.3%比46.2%,（P=0.46）,切除膀胱率25.0%比46.2%,（P=0.21）。结论 对于极高危非肌层浸润性膀胱癌患者,在经尿道电切术后辅助双侧髂内动脉化疗栓塞有助于延缓疾病的复发。     

髂内动脉化疗栓塞联合经尿道膀胱肿瘤电切术治疗晚期膀胱癌17例

目的评价经髂内动脉灌注化疗并栓塞治疗后联合经尿道膀胱肿瘤切除治疗晚期膀胱癌的疗效。方法对17例经CT检查及膀胱镜下肿块活检病理证实为肌层浸润的晚期膀胱移行细胞癌的患者,采用行经皮穿刺股动脉插管,用选择性插管技术经髂内动脉灌注化疗栓塞后再行经尿道膀胱肿瘤电切治疗膀胱癌17例。结果 17例晚期膀胱癌患者行经髂内动脉化疗栓塞治疗后,14例肿瘤体积有不同程度的缩小,3例术后肿块无明显改变,但血尿症状有明显减轻。17例患者均行经尿道膀胱肿瘤电切治疗,术后存活10～62(平均43.5)个月。结论对于老年晚期膀胱癌患者,可选择采用髂内动脉化疗栓塞治疗能缩小肿瘤体积,明显减少围手术期出血,结合经尿道膀胱肿瘤电切术,能延长患者的生存时间,改善其生活质量,可以最大限度保留膀胱功能,并发症较少,是一种安全有效的姑息性治疗方法。     

多元化治疗复发性膀胱肿瘤的18例

目的:探讨复发性膀胱肿瘤的治疗途径,延长患者的生存时间、提高生活质量.方法:对18例有全膀胱切除指征,接受膀胱全切的浸润性、多发性和复发性膀胱肿瘤患者进行保留膀胱的治疗,采用骼内动脉化疗及栓塞、经尿道膀胱肿瘤电切结合术后膀胱灌注等多元化治疗方法.在硬外麻或椎管内麻醉下行经尿道膀胱内肿瘤汽化电切术(TURBt).结果:18例患者经本综合方法治疗,10例(55.6%)仅一个疗程因微小病灶复发进入了第二个疗程,15例(83.3%)经膀胱镜检查未见复发,1例(0.06%)因双肾转移死亡,2例因非肿瘤原因发生死亡.结论:骼内动脉化疗栓塞联合TURBt加膀胱内灌注化疗的多元化治疗方法,结合对症处理、规律的随访,为复发性膀胱癌患者提供了一种较为安全有效的治疗方法.     

浸润性膀胱癌48例钬激光综合治疗疗效分析

目的 探讨肌层浸润性膀胱癌保留膀胱手术即钬激光肿瘤汽化剜除术＋膀胱内灌注化疗治疗的临床疗效。方法对2006年4月~2010年6月经尿道膀胱肿瘤钬激光剜除术后确诊为肌层浸润性膀胱癌（T2N0M0）并保留膀胱的48例患者,术后给予膀胱灌注化疗并进行回顾性分析。结果48例患者均获得随访,随访时间36个月,平均32.0个月。46例患者无复发及转移。2例术后复发。复发患者均行全膀胱切除术,无死亡病例。无明显并发症。结论对采用钬激光剜除术保留膀胱手术的肌层浸润性膀胱癌患者,术后采用膀胱内灌注化疗的治疗方法,能有效减少肿瘤复发,提高患者的生活质量。     

PK-TURBT联合羟喜树碱治疗非肌层浸润性膀胱癌

目的探讨经尿道等离子双极膀胱肿瘤电切术(PK-TURBT)联合羟基喜树碱膀胱灌注治疗非肌层浸润性膀胱癌的临床疗效。方法 66例非肌层浸润性膀胱癌患者在硬腰麻醉或腰硬联合麻醉下行PK-TURBT,术后定期给予羟基喜树碱膀胱灌注治疗,每3个月复查泌尿系超声和膀胱镜1次。结果 66例均顺利完成手术,手术时间平均40 min。5例发生闭孔神经反射,无膀胱穿孔及电切综合征发生。术后随访6～32个月,7例复发,再次行PK-TURBT,术后病情稳定,随访至今未复发。结论 PK-TURBT联合羟基喜树碱术后膀胱灌注化疗治疗非肌层浸润性膀胱癌疗效确切,安全性好。     

经尿道铥激光切除联合术后介入化疗治疗浸润性膀胱癌

<正>目的:探讨腔内经尿道铥激光切除联合并术后介入化疗治疗浸润性膀胱癌的疗效及安全性。方法:浸润性膀胱癌患者26例,其中多发肿瘤18例,单发肿瘤8例。肿瘤直径2.0～4.0cm,基底宽。行经尿道铥激光治疗。术后1周,行经股动脉致膀胱动脉介入化疗。结果:26例膀胱肿瘤均一次切除,切除范围距离肿瘤边缘正常黏膜1.0cm,深度达深肌层,平均手术时间35min。无明     

髂内动脉化疗联合手术治疗膀胱癌

目的：提高膀胱癌手术治疗的效果，尽可能保留有功能的膀胱，降低膀胱癌术后复发率。方法：对72例不同分期、分级的膀胱移行细胞癌患者随机分为两组，Ⅰ组40例行膀胱部分切除术或经尿道膀胱肿瘤电切术（TUR—Bt），术后加丝裂霉素膀胱灌注化疗；Ⅱ组32例术前行卡铂配伍阿霉素髂内动脉灌注化疗2次，后行膀胱部分切除术或经尿道膀胱肿瘤电切术，术后加丝裂霉素膀胱灌注化疗。均随诊2年，比较两组间治疗后膀胱癌复发率。结果：Ⅰ组，2年膀胱癌复发18例，复发率45％。Ⅱ组，2年膀胱癌复发6例，复发率18．75％。两组复发率比较差异有显著性（P〈0．05）。Ⅱ组髂内动脉灌注化疗前后膀胱癌细胞分级（G）降低15例，分期（T）降低16例。结论：术前加用卡铂配伍阿霉素髂内动脉灌注化疗可使部分膀胱癌降级、降期，提高手术切除率，降低术后膀胱癌复发率，术前加用卡铂配伍阿霉素髂内动脉灌注化疗结合保留膀胱的手术是治疗膀胱癌的有效方法。     

经尿道双极等离子体汽化电切术治疗浅表性膀胱肿瘤的疗效观察

目的观察经尿道双极等离子体膀胱肿瘤汽化电切术治疗浅表性膀胱肿瘤的治疗效果。方法对66例浅表性膀胱肿瘤患者行经尿道双极等离子体汽化电切术治疗,术后常规行膀胱化疗药物灌注。结果 66例膀胱肿瘤患者均1次手术切除。手术时间3~55 min,平均(22±15)min,术中均未输血,有2例在肿瘤切除时发生穿孔。术后留置F22三腔单囊管3~5 d拔管,术后有2例行膀胱点滴冲洗24h,无经尿道电切(TUR)综合征发生,无死亡病例。2例术后并发尿道外口狭窄,经尿道扩张后治愈。随访3~48个月,12例复发(18.18%)。结论经尿道双极等离子体膀胱肿瘤汽化电切术具有操作简单、出血少、恢复快、术后并发症低等优点。     

经尿道汽化切除膀胱肿瘤25例

我院1997年1月始,对诊断为浅表肌层浸润(T2)以下的膀胱移行上皮细胞癌25例采用经尿道汽化切除术,疗效满意。1　临床资料1.1　一般情况　本组男19例,女6例;年龄38～78岁。均有无痛性全程血尿,术前经膀胱镜、B超及CT检查,诊断为T1～T2期膀胱肿瘤,病理证实为膀胱移行上皮细胞癌。单发肿瘤22例,多发肿瘤3例。1.2　手术方法　均采用硬膜外麻醉,冲洗液为5%葡萄糖液。应用美国ACMI汽化电极,在电视显像系统下操作。用顺行切除法,先切除瘤体和蒂部,最后烧灼肿瘤基底周围1～2cm的膀胱粘膜,均达肌层。输尿管开口处肿瘤连同输尿管口一并汽化加电切,…     

Effective bladder preservation strategy with low-dose radiation therapy and concurrent intraarterial chemotherapy for muscle-invasive bladder cancer

Purpose The aim of this study was to evaluate retrospectively the toxicity and response, bladder preservation, and survival of patients with muscle-invasive bladder cancer treated with multimodality therapy consisting of low-dose radiation therapy (RT) and concurrent intraarterial chemotherapy (IACT). Methods and materials Between November 1999 and July 2005, a total of 27 consecutive, previously untreated patients with muscle-invasive bladder cancer underwent transurethral bladder tumor resection followed by concurrent low-dose RT and IACT. Patients who achieved a complete response (CR) were followed up closely without further therapy, and patients who did not achieve a CR underwent further treatment. Results Complete response was achieved in 22 of 27 patients (81%). Of these 22 patients, 7 developed recurrences, and 3 died of their disease. In five patients who did not achieve CR, one died from bone metastases. The 3-year overall survival rate was 81%, with a median follow-up time of 27 months; and 22 of 27 patients (81%) with a preserved bladder were tumor-free at the last follow-up. Three patients (11%) developed grade 3 acute hematological toxicity. Conclusion Multimodality therapy consisting of low-dose RT and concurrent IACT for muscle-invasive bladder cancer can achieve survival rates similar to those in patients treated with radical cystectomy, with successful bladder preservation and minimal adverse effects.     

Radiotherapy is an Effective Treatment for High-Risk T1-Bladder Cancer

PURPOSE: Current treatment options for high-risk superficial T1-bladder cancer (Grade 3, associated Tis, multifocality, tumor diameter > 5 cm or multiple recurrences) include early cystectomy or the goal of organ preservation by adjuvant intravesical therapy after transurethral resection (TURB). We have evaluated the efficacy of adjuvant radiotherapy or radiochemotherapy on local control, bladder preservation, recurrence rate and long-term survival after TURB of high-risk T1-bladder cancer. PATIENTS AND METHODS: From May 1982 to May 1999, a total of 74 patients with T1-bladder cancer were treated by either radiotherapy (n = 17) or concomitant radiochemotherapy (n = 57) after TURB. Radiotherapy was initiated 4 to 8 weeks after TURB; a median dose of 54 (range: 45 to 60) Gy was applied to the bladder with daily fractions of 1.8 to 2.0 Gy. Since 1985 chemotherapy has been given in the 1st and 5th week of radiotherapy and consisted of cisplatin (25 mg/m2/d) in 33 patients, carboplatin (65 mg/m2/d) was administered in 14 patients with decreased creatine clearance (< 50 ml/min). Since 1993 a combination of cisplatin (20 mg/m2/d) and 5-fluorouracil (600 mg/m2/d) was applied to 10 patients. Salvage cystectomy was recommended for patients with refractory disease or invasive recurrences. At the time of analysis, the median follow-up for surviving patients was 57 (range: 3 to 174) months. RESULTS: After radiotherapy/radiochemotherapy, a complete remission at restaging TURB was achieved in 62 patients (83.7%), 35 of whom (47% with regard to the total cohort of the 74 treated patients) have been continuously free of tumor, 11 patients (18%) experienced a superficial relapse and 16 patients (26%) showed tumor progression after initial complete response. Overall-survival was 72% at 5 years and 50% at 10 years with 77% of the surviving patients maintaining their own bladder at 5 years. Negative prognostic factors for cancer-specific survival were non-complete (R1/2) initial TURB (p = 0.12) and recurrent disease (p = 0.07); combined radiochemotherapy was more effective than radiotherapy alone (p = 0.1). CONCLUSION: Adjuvant radiotherapy/radiochemotherapy offers an additional option in high-risk superficial bladder cancer with a high chance of cure and bladder preservation. The ultimate value of radiotherapy in comparison with other treatment options should be determined in randomized trials.     

Radiotherapy alone or radiochemotherapy with platin derivatives following transurethral resection of the bladder

Purpose

Multivariate analysis of prognostic factors influencing survival and bladder preservation after radiochemotherapy for bladder cancer following transurethral resection of the bladder (TURB)

Patients and Methods

At the University Hospital of Erlangen 333 patients with bladder cancer were treated with either radiotherapy alone (RT, n=128) or platin based radiochemotherapy (RCT, n=205) after TURB between 5/1982 and 5/1996. Two-hundred and eighty-two curative patients, with either muscle invasive or T1-high risk cancer, were analyzed. Median age was 66 years, median follow-up is 7.5 years. Uni- and multivariate analysis was performed for age, grade, R-status after initial TURB, T-category and treatment modality relevant to the endpoints initial response, survival and bladder preservation.

Results

Treatment related mortality was below 1%. Complete remissions were achieved at 57%, 70%, and 85% after RT or RCT with carbo- or cisplatin. This difference was multivariately significant. Further significant prognostic factors were pT-category and R-status. For all patients survival was 59% and 43% after 5 and 10 years. 79% of survivors could keep their own bladder. Five-year survival rates after RT alone, RCT with carbo- or cisplatin were 47%, 57%, and 69%, respectively. This was univariately significant. The only multivariately significant factor for survival and bladder preservation was the R-status after initial TURB.

Conclusions

Treatment of bladder cancer by TURB and RT/RCT is an alternative to primary cystectomy. The addition of chemotherapy leads to significantly more complete remissions and better survival. Initial TURB is recommended to be as radical as possible.     

Effective bladder preservation strategy with low-dose radiation therapy and concurrent intrarrterial chemotherapy for muscle-invasive bladder cancer

Purpose

The aim of this study was to evaluate retrospectively the toxicity and response, bladder preservation, and survival of patients with muscle-invasive bladder cancer treated with multimodality therapy consisting of low-dose radiation therapy (RT) and concurrent intraarterial chemotherapy (IACT).

Methods and materials

Between November 1999 and July 2005, a total of 27 consecutive, previously untreated patients with muscle-invasive bladder cancer underwent transurethral bladder tumor resection followed by concurrent low-dose RT and IACT. Patients who achieved a complete response (CR) were followed up closely without further therapy, and patients who did not achieve a CR underwent further treatment.

Results

Complete response was achieved in 22 of 27 patients (81%). Of these 22 patients, 7 developed recurrences, and 3 died of their disease. In five patients who did not achieve CR, one died from bone metastases. The 3-year overall survival rate was 81%, with a median follow-up time of 27 months; and 22 of 27 patients (81%) with a preserved bladder were tumor-free at the last follow-up. Three patients (11%) developed grade 3 acute hematological toxicity.

Conclusion

Multimodality therapy consisting of low-dose RT and concurrent IACT for muscle-invasive bladder cancer can achieve survival rates similar to those in patients treated with radical cystectomy, with successful bladder preservation and minimal adverse effects.     

Intraarterial low-dose cisplatin via an indwelling port and concurrent radiotherapy for invasive bladder cancer

Thirteen patients with invasive bladder cancer who had residual tumor after transurethral resections, were treated with consecutive intraarterial (IA) cisplatin (15 mg/d; total, 150 mg) and concurrent radiation (1.8 Gy/d; total, 30.6 Gy). All patients received unilateral or bilateral placement of vascular access devices (VAD) to perform daily cisplatin infusion after alteration of intrapelvic blood flow by coil embolizations. Tumor response was evaluated by transurethral biopsy 2 weeks after treatment. Complete response, defined as no viable tumor cell in the biopsy specimen, was achieved in seven patients (54%). After a median follow-up of 30 months (range, 12-48 months), 10 patients (77%) were alive, five (38%) of whom had no recurrence. Two cancer-related deaths were observed. All complete response cases survived with a median follow-up of 35 months (range, 25-48 months). Cause-specific and disease-free survival rates at 4 years were 85% and 28%, respectively. The regimen was well-tolerated, with no dose-limiting toxic events. There were no VAD-related complications. Consecutive IA low-dose cisplatin and concurrent radiation may be an acceptable alternative treatment for patients with bladder cancer who are not suitable for systemic chemotherapy. The use of a VAD contributed to successful consecutive IA infusions.     

经尿道电切治疗膀胱浅表性肿瘤的临床观察及分析

目的探讨经尿道膀胱肿瘤电切术（Transurethral resection of bladder tumor,TUR-Bt）治疗膀胱肿瘤的治疗效果及手术安全性。方法对我院2006年9月～2010年12月收治的46例膀胱浅表肿瘤患者实行经尿道膀胱肿瘤电切术的病例进行回顾性分析。结果 46例均1次手术切除成功,术后均予用丝裂霉素40mg定期膀胱灌注治疗。术后情况较好;肿瘤术后复发8例,其中5例再次行经尿道膀胱肿瘤电切术后未复发,3例因肿瘤进展改行全膀胱根治性切除治疗。结论 TUR-Bt对治疗膀胱浅表性肿瘤具有微创、操作简单、出血少、痛苦小、安全性好、恢复快、费用低、并发症发生率低等优点。     

髂内动脉化疗栓塞药泵置入联合手术治疗浸润性膀胱癌

目的：探讨治疗浸润性膀胱癌的有效方法。方法：对60例经手术、病理证实并获随访的浸润性膀胱癌患者分为A、B两组,A组30例为髂内动脉化疗栓塞药泵置入后手术治疗组,B组30例为单纯手术治疗组,分析比较两组患者术后复发率、病死率的差异,了解介入联合手术治疗的效应。结果：A组患者术前髂内动脉化疗栓塞后完全缓解率（CR）为16．7％（5／30）,部分缓解率（PR）为70％（21／30）,有效率（CR＋PR）为86．7％。术后切除标本病理检查光镜下可见大片状癌细胞变性坏死,间质见炎细胞浸润。A组死亡4例（13．3％）,B组死亡8例（26．7％）。A组复发6例（20％）,B组复发14例（46．7％）。结论：髂内动脉化疗栓塞药泵置人后手术治疗浸润性膀胱癌,安全有效,能显著提高膀胱癌的疗效。     

Current Status of Radiation Therapy and Combined-Modality Treatment for Bladder Cancer

BACKGROUND: Standard treatment for muscle-invasive bladder cancer is radical cystectomy. Combined-modality treatment (CMT), including transurethral resection (TURBT), radiation therapy (RT) and systemic chemotherapy, has been shown to produce survival rates comparable to those of radical cystectomy. With these programs, cystectomy has been reserved for patients with incomplete response or local relapse after trimodality treatment. METHODS: This review summarizes series of radical RT with different fractionation schedules and focuses on CMT for muscle-invasive bladder cancer. Current protocols of the bladder-sparing approach will be discussed and the background of future developments, including incorporation of promising new chemotherapeutic agents as well as the role of predictive and prognostic factors in selecting patients for the respective treatment alternatives, will be given. RESULTS: There is moderate evidence that hyperfractionated and accelerated regimens are superior to conventional RT at least in situations where no concomitant chemotherapy is applied. Several phase II studies and one phase III study indicate that concomitant radiochemotherapy is superior to RT alone. In modern series of CMT, 5-year survival rates in the range of 50-60% have been published, and about three quarters of the surviving patients maintained their own bladder. Recent data suggest that incorporation of newer chemotherapeutic agents, particularly gemcitabine and taxanes, in CMT protocols is feasible and promising. Clinical criteria helpful in determining patients for bladder preservation include such variables as early tumor stage, unifocal tumor, a visibly and microscopically complete TURBT, and absence of ureteral obstruction. CONCLUSION: CMT for bladder cancer is a reasonable treatment option for patients who are deemed medically unfit for cystectomy and for those seeking an alternative to radical cystectomy.     

BPH患者尿动力学检查结果及其在指导治疗中的作用

目的观察良性前列腺增生症（BPH）患者尿流动力学相关参数,并评价尿流动力学检查结果对指导BPH治疗的价值。方法对119例BPH患者,治疗前后分别进行尿流动力学检查、国际前列腺症状评分（IPSS）和生活质量评估（QOL）并分析检查结果。结果 119例患者中有4例可疑梗阻,3例无梗阻,7例逼尿肌收缩乏力,105例膀胱出口梗阻（BOO）。BOO患者中伴不稳定膀胱41例（39.05%）,低顺应性膀胱19例（18.10%）,不稳定膀胱合并低顺应性膀胱16例（15.24%）。根据测定结果选用不同方法治疗,其中行经尿道前列腺电切术（TURP）103例,行耻骨上经膀胱前列腺摘除术2例,膀胱造瘘术7例,保守治疗7例。治疗后4～6个月复查,比治疗前症状明显改善,取得满意疗效。结论尿流动力学检查可以明确BPH患者有无BOO及梗阻程度如何,又可了解膀胱功能和逼尿肌稳定性,为临床鉴别诊断、选择合理的治疗方案和估计预后提供依据,对提高疗效具有重要的临床意义。