THP和MMC膀胱内灌注治疗浅表性膀胱癌疗效观察

目的评价吡柔比星（THP）、丝裂霉素C（MMC）两种药物膀胱灌注治疗浅表性膀胱癌的不同疗效。方法将64例浅表性膀胱癌随机分为两组,分别用THP和MMC作膀胱灌注治疗药物,观察其不同疗效。结果所有病例随访3～24个月,平均14个月。THP组复发率11.76%（4/34）,MMC组复发率23.33%（7/30）,差别具有统计学意义（P〈0.05）。结论 THP膀胱灌注防治浅表性膀胱癌术后复发的疗效优于MMC,可作为临床一线用药。     

吡柔比星与卡介苗交替灌注预防浅表性膀胱癌术后复发的疗效观察

目的观察吡柔比星(THP)与卡介苗(BCG)交替灌注的化学免疫疗法预防浅表性膀胱癌术后复发的疗效。方法将128例行经尿道膀胱癌电切术的浅表性膀胱癌患者,随机分为3组:Ⅰ组行THP与BCG交替灌注(48例)、Ⅱ组行THP灌注(40例)、Ⅲ组行BCG灌注(40例),随访5年,比较三组肿瘤复发率。结果随访18月~5年,平均4.2年,三组患者复发率分别为8.3%(4/48)、17.5%(7/40)和20%(8/40),Ⅱ、Ⅲ组比较差异无统计学意义(P>0.05),Ⅰ组复发率低于Ⅱ、Ⅲ组(P<0.05)。结论吡柔比星与卡介苗交替灌注的化学免疫疗法明显降低了浅表性膀胱癌的术后复发率,优于单用化疗药物或免疫制剂。     

鸦胆子油乳膀胱灌注联合体外热疗预防浅表性膀胱癌术后复发的疗效观察

目的观察鸦胆子油乳膀胱灌注联合体外热疗预防浅表性膀胱癌术后复发的疗效。方法将66例浅表性膀胱癌术后患者按数字表法随机分为A组(34例)和B组(32例)。A组采用鸦胆子油乳膀胱灌注联合体外热疗方法治疗;B组采用单独鸦胆子油乳膀胱灌注方法治疗。对两组患者随访2年,观察肿瘤复发及药物副作用情况。结果 A组复发2例,复发率为5.88%,B组复发4例,复发率12.5%,A组复发率较B组显著降低(P<0.05),且无一例有全身性药物及局部不良反应。结论鸦胆子油乳膀胱灌注联合体外热疗预防浅表性膀胱癌术后复发有良好的效果,且无毒副作用。     

鸦胆子油乳膀胱内灌注预防浅表性膀胱癌术后复发

目的评价鸦胆子油乳膀胱灌注预防浅表性膀胱癌术后复发的疗效和安全性。方法对365例浅表性膀胱癌患者行TURBT或膀胱部分切除术,术后1周给予10%鸦胆子油乳60 m l膀胱内灌注,药物于膀胱内保留2 h,每周1次,连续6周,以后每月1次,连续12个月。定期做血、尿常规、肝肾功能及膀胱镜检查,并记录每次膀胱灌注后的全身及局部反应。结果365例均未见全身性药物不良反应,随访9~36个月,平均23个月,复发35例,复发率9.6%。结论鸦胆子油乳膀胱灌注防止浅表性膀胱癌术后复发疗效满意,安全性好。     

盐酸米托蒽醌膀胱灌注预防膀胱癌术后复发

目的：探讨米托蒽醌（MTZ）在预防膀胱癌术后复发中的作用。方法：对行保留膀胱手术治疗的18例膀胱癌患者，术后2周予以盐酸米托蒽醌12mg＋生理盐水50ml灌注，药物于膀胱内保留2h，1次／周，连续8周；然后1次/月，连续12个月。定期做血、尿常规和肝、肾功能及膀胱镜检查。结果：18例均获得随访，随访时间6～18个月，平均12个月，其中复发2例，复发率11．1％。结论：盐酸米托蒽醌膀胱灌注预防膀胱癌术后复发具有较好的临床效果及安全性，值得临床推广使用。     

表柔比星联合卡介苗膀胱灌注预防膀胱癌术后复发的临床研究

目的比较表柔比星(EPI)联合卡介苗(BCG)与单用表柔比星膀胱灌注预防膀胱癌术后复发的疗效及安全性。方法确诊膀胱移行上皮癌,病理结果Ⅰ～Ⅱ期的患者36例,行经尿道膀胱肿瘤电切术后随机分成联合组、单用组,每组18例。联合组术后第1周灌注EPI,第2周灌注BCG,每周交替使用灌注药物,共8次后,用BCG每月1次灌注,共8次;单用组术后每周灌注EPI,共8次后,用EPI每月1次灌注,共8次。比较两组治疗后3年内的膀胱肿瘤复发情况、药物治疗期间泌尿系感染及不良反应的发生率。结果两组患者治疗后3年内的膀胱肿瘤复发率方面,联合组与单用组比较差异无统计学意义;药物治疗期间泌尿系感染与不良反应发生率方面,联合组较单用组比较发生率更低,差异具有统计学意义。结论 EPI联用NCG和EPI单用均具有良好的预防肿瘤复发效果,而EPI联用BCG可显著减少治疗期间的泌尿系感染和不良反应发生,患者依从性更好。     

丝裂霉素C和卡介苗序联灌注预防膀胱癌术后复发47例

膀胱腔内灌注局部化疗或免疫治疗是预防膀胱肿瘤术后复发的一个重要手段。我院自1994年6月～2002年12月应用丝裂霉素C(Milomycin C,MMC)和卡介苗(Bacillus Calmette-Guerin,BCG)顺序联合膀胱灌注预防浅表性膀胱癌局部切除术后复发47例,经随访观察,疗效满意,现报道如下。     

18例高龄浅表性膀胱肿瘤临床治疗体会

目的总结经尿道膀胱肿瘤电切加膀胱内灌注治疗高龄浅表性膀胱肿瘤的疗效。方法采用经尿道膀胱肿瘤电切,联合术后膀胱灌注治疗浅表性膀胱肿瘤18例,男14例,女4例,平均年龄84.7岁,肿瘤单发15例,多发3例,病理分级为TaG1 7例,T1G1 11例,肿瘤直径0.5～4cm。结果手术均一次成功,手术时间10～35min,术中平均出血量<20ml,无膀胱穿孔、尿路感染以及术后继发性出血等严重并发症。术后创面基底及创缘病理检查无残余肿瘤,术后均行吡柔比星膀胱灌注化疗。16例随访3～20个月,平均9.5个月,复发2例,复发率11%。结论经尿道膀胱肿瘤电切加膀胱内灌注化疗治疗高龄浅表性膀胱肿瘤是安全、理想的方法。     

羟基喜树碱膀胱灌注预防浅表性膀胱癌复发的观察和护理

膀胱癌是泌尿系统最常见的恶性肿瘤,其中移行细胞癌约占膀胱肿瘤的86%[1],浅表性膀胱癌在经尿道膀胱肿瘤切除（transurathral resection of bladder tumor TURBt）术后1年复发率约10%～67%,5年复发率约24%～84%,多为异位复发。为提高患者的生存率,降低术后复发,术后膀胱灌注化疗是目前最常用的预防措施,且方法简单,疗效满意。     

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。     

Neurogenic bladder simplified

Neurogenic bladder dysfunction, if not properly diagnosed and treated, can lead to rapid deterioration of renal function by compromise of the upper urinary tracts. Two major categories of neurogenic bladder (detrusor hyperreflexia areflexia) have been discussed including the pathophysiology of the voiding dysfunction and the typical radiographic findings. Radiologists studying patients with suprasacral cord lesions should be aware of the causes, symptoms, and treatment of autonomic dysreflexia. Although video urodynamics is the state-of-the-art modality for evaluating complex or refractory neurogenic bladder, the practicing radiologist with an understanding of this condition can detect many radiographic changes in the lower urinary tract that suggest neurogenic dysfunction of various types.     

Idiopathic bladder rupture

Deaths due to hemoperitoneum are not rare and can result from a variety of underlying pathologic processes, including natural disease as well as trauma. Whenever hemoperitoneum is identified at autopsy, it is incumbent upon the pathologist to identify the source of the hemorrhage. The authors present a case of probable traumatic rupture of the urinary bladder that resulted in lethal intra-abdominal hemorrhage, occurring in a young man who was found dead the morning after drinking heavily.     

Imaging of bladder cancer

Bladder cancer is a heterogeneous and frequently multifocal disease with a variable clinical course. The management of bladder cancer is therefore challenging and complicated. CT and MR imaging have replaced the traditional excretory urography and are emerging as the imaging modalities of choice for work-up of patients who have bladder cancer. Imaging provides essential diagnostic information for detection, staging, and post-treatment follow-up of bladder cancer.     

Leiomyoma of the bladder

A case of leiomyoma of the bladder in a 37-year-old man is described. Clinical features and findings on excretory urography resembled a malignant tumor of the small pelvis. Ultrasound, computed tomography, and angiography nevertheless made the correct preoperative diagnosis. Special emphasis is given to the differentiation between benign and malignant smooth muscle neoplasms.     

Leiomyoma of the bladder

A case of leiomyoma of the bladder in a 37-year-old man is described. Clinical features and findings on excretory urography resembled a malignant tumor of the small pelvis. Ultrasound, computed tomography, and angiography nevertheless made the correct preoperative diagnosis. Special emphasis is given to the differentiation between benign and malignant smooth muscle neoplasms.     

Multichambered bladder anomalies.

This report reviews multichambered bladder conditions, offers a workable classification of them, presents a detailed case report, and discusses the possible causes of these anomalies. We wish to stress the importance of careful examination of the genital area in the newborn and early roentgenologic evaluation of the genito-urinary system when an anomaly is found.