经尿道钬激光治疗浅表性膀胱癌

目的探讨钬激光（Ho：YAG）治疗浅表性膀胱癌的方法及疗效。方法采用经尿道钬激光治疗浅表性膀胱癌12例。结果所有患者手术均一次成功，无并发症，包括严重出血、膀胱穿孔及闭孔神经反射等。12例获随访，随诊时间5～13个月，1例膀胱肿瘤异位复发，无原位复发。结论经尿道钬激光治疗浅表性膀胱癌具有操作简单、副反应少、安全有效等优点，可望成为治疗浅表性膀胱癌的一种标准术式。     

表阿霉素单次膀胱灌注预防浅表性膀胱癌术后复发的前瞻性随机对照研究

目的　比较单次、多次表阿霉素和丝裂霉素、BCG膀胱腔内灌注预防浅表性膀胱移行细胞癌术后复发的作用。　方法　前瞻性随机对照研究 ,12 3例患者分为 4组 ,A组在术后 6h内表阿霉素 80mg单次灌注 ,B组、C组和D组分别于术后 2周内表阿霉素 4 0mg、丝裂霉素 2 0mg、BCG12 0mg多次灌注 ,观察术后复发率和无肿瘤间期及副作用发生情况。　结果　随访期 10～ 2 5个月 ,平均 18.6个月。A组复发率 18.8%、B组 14 .7%、C组 2 0 .7%、D组 17.9%。各组之间复发率及Ka plan Meier无肿瘤间期分析显示差异均无显著性意义 (P >0 .0 5 ) ,BCG组副作用明显高于其他 3组(P <0 .0 5 )。　结论　表阿霉素单次膀胱腔内灌注对预防早期、分化良好的初发浅表性膀胱移行细胞癌术后复发效果可靠 ,副作用发生率低 ,且费用低廉。     

表阿霉素改良膀胱灌注预防浅表性膀胱癌术后复发18例体会

我们自2000年12月起对18例浅表性膀胱癌经尿道膀胱肿瘤电切(TUBT)后应用表阿霉素(EPI)改良膀胱灌注方案预防肿瘤复发，疗效及安全性满意，报告如下。     

钬激光联合膀胱灌注治疗浅表性膀胱肿瘤(附30例报告)

目的　总结应用钬激光 (Ho :YAG激光 )治疗浅表性膀胱肿瘤的疗效。　方法　采用钬激光经尿道切除肿瘤 ,联合术后膀胱灌注治疗浅表性膀胱肿瘤 30例。男 2 5例 ,女 5例。平均年龄 5 4岁。肿瘤单发 15例、多发 15例。病理分级G1～G2 ,分期T1～T2 。肿瘤直径 0 .2～ 3.5cm。　结果　手术均一次成功 ,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。手术时间平均 18min ,术中平均出血量 <15ml,无膀胱穿孔或术后继发性出血等严重并发症。 30例随访 3～ 14个月 ,平均 7.5个月 ,复发 1例 ,复发率 3%。　结论　经尿道钬激光切除膀胱肿瘤操作简单 ,疗效确切 ,术中、术后无严重并发症 ,是治疗浅表性膀胱肿瘤的一种理想手术方法。     

大功率钬激光治疗多发性膀胱癌(附4例报告)

本报道应用大功率钬激光切除多发性膀胱肿瘤4例的技术与疗效。手术均顺利，手术可从肿瘤任何部位进行，操作易掌握，无需麻醉，病人痛苦小，出血极少，无并发症。随访（4～8）月无复发。     

表阿霉素黏膜下浸润注射加单次灌注预防浅表性膀胱癌术后复发的研究

目的　探讨表阿霉素膀胱黏膜下浸润注射和术后立即单次膀胱灌注预防浅表性膀胱癌术后复发的临床效果。　方法　浅表性膀胱癌 36例 ,Ta10例 ,T12 6例 ;G111例 ,G2 2 0例 ,G3 5例 ,均行膀胱部分切除。术中采用 1mg/ml浓度的表阿霉素多中心膀胱黏膜下浸润注射 ,总量 30mg。手术结束时立即单次膀胱灌注表阿霉素 12 0mg。 36例患者术后随访 1～ 4年 ,平均 2 .8年。　结果　 36例患者术后 1、2、3年无瘤生存率分别为 10 0 .0 %、91.7%、88.9% ,总复发率 11.1% ( 4 / 36 )。手术前后肝肾功能及心电图无显著性变化。术后早期并发症主要为血尿和膀胱刺激症状 ,膀胱局部毒性反应发生率为 2 7.8% ( 10 / 36 ) ,全身性毒性反应发生率 8.3% ( 3/ 36 )。　结论　术中多中心表阿霉素膀胱黏膜下浸润注射结合单次膀胱灌注预防浅表性膀胱癌术后复发效果良好 ,操作简便 ,费用低 ,毒副作用小     

经尿道钬激光切除浅表性膀胱癌的临床体会

目的 探讨经尿道钬激光切除非肌层浸润性膀胱癌的疗效及安全性。方法 对65例采用经尿道钬激光切除治疗的非肌层浸润性膀胱癌患者的临床资料进行分析。该组患者术前膀胱镜活检组织病理均提示低级别尿路上皮癌。结果 65例患者手术均一次成功,平均手术时间22 min（18～45 min）,术中无明显出血、闭孔神经反射、膀胱穿孔,术后无继发性大出血及尿失禁等并发症。术后留置导尿2～3d。术后创面基底及创缘病理检查无残余肿瘤。术后住院2～3d。术后均按常规方法定期吡柔比星膀胱灌注,定期膀胱镜复查。术后随访平均15个月（3～32个月）,2例为膀胱手术区复发,3例为膀胱非手术区再发,复发加再发率为7.7%。再次行钬激光治疗,现仍在随访中,未见复发。结论 经尿道钬激光切除非肌层浸润性膀胱癌操作简便、安全、灵活、创伤小、并发症少、疗效确切。     

单次腔内灌注表阿霉素预防浅表性膀胱癌术后复发的长期随访研究

目的　探讨表阿霉素单次腔内灌注预防浅表性膀胱癌术后复发的长期随访效果。　方法　浅表性膀胱癌 (Ta～ 1,G1～ 2 ) 4 7例。男 2 9例 ,女 18例。年龄 4 5～ 79岁。随机分为 3组 ,A组 (16例 )术后 6h内单次灌注表阿霉素 80mg ;B组 (15例 ) 10d内灌注 4 0mg ,以后每周 1次 ,8～ 10次后改为每月 1次 ,至术后 1年 ;C组 (16例 )用药为丝裂霉素 ,剂量及方法同B组。采用前瞻性、随机对照临床研究 ,随访 5年 ,记录患者无瘤生存期、肿瘤复发率及不良反应发生情况。　结果　随访 5年 ,4 7例中除A组 1例死于意外、1例死于其它疾病、C组 1例死于肺癌外 ,其余 4 4例均未因膀胱癌复发死亡 ,各组患者无瘤生存期无统计学差异 (F =10 .2 8,P >0 .0 5 )。 3组患者术后 5年肿瘤复发率分别为 36 %(5 / 14 )、33% (5 / 15 )、4 0 % (6 / 15 ) ,差异无显著性意义 (χ2 =0 .83,P >0 .0 5 )。 3组患者出现药物性膀胱炎者分别为 1、2、2例 ,B、C两组各有 1例尿道狭窄。总不良反应发生率分别为 14 % (2 / 14 )、5 3% (8/15 )和 4 7% (7/ 15 ) ,A组与B、C两组相比差异有非常显著性意义 (χ2 =12 .2 1,P <0 .0 1)。　结论　表阿霉素单次腔内灌注预防浅表性膀胱癌术后复发长期效果良好。     

表阿霉素预防浅表性膀胱肿瘤术后复发的研究

目的研究表阿霉素预防浅表性膀胱肿瘤术后复发的可能机制。方法通过细胞培养、免疫组织化学研究不同浓度表阿霉素对膀胱肿瘤EJ细胞株的Ki-67的表达的影响，RT—PCR方法检测术前24h分别接受生理盐水、阿霉素、表阿霉素膀胱灌注患者膀胱肿瘤组织Fas—mRNA的表达。结果0、30、60、90mg／L表阿霉素各浓度组Ki-67的阳性率分别为79．60±3．50、60．73±3．31、51．57±3．93、45．83±3．75（P〈0．01）；表阿霉素较生理盐水可以明显促进肿瘤组织中Fas—mRNA的表达（P〈0．01）表阿霉素组和阿霉素组比较差异无统计学意义（P〈0．05）。结论表阿霉素可能通过下调Ki-67抑制膀胱肿瘤细胞增殖，促进Fas—mRNA的表达诱导凋亡达到抗肿瘤作用．     

浅表性膀胱癌的灌注治疗

膀胱癌是我国泌尿系统最常见的恶性肿瘤，90％以上为移行细胞癌(transient cell carcinoma，TCC)。初次就诊的患者中70％～80％为浅表性膀胱癌(superficial transient cell carcinoma，STCC)，包括Tis、Ta及T1，不论肿瘤分化程度的高低，都未侵及膀胱肌层。经尿道切除术或者膀胱部分切除术可以切除原发肿瘤，但由于STCC的多中心性和多发性特点．复发率高达30％～85％，复发的患者中有30％～40％会进展为浸润性膀胱癌。自上个世纪60年代起开始的膀胱内灌注治疗有效延缓或者阻止了肿瘤的复发和进展。     

Holmium:YAG laser vaporization of recurrent papillary tumours of the bladder under local anaesthesia

OBJECTIVES: To evaluate holmium:YAG laser vaporization of papillary tumours of the bladder, focusing on surgical technique, patients' satisfaction, complications and cost-effectiveness when using the technique under local anaesthesia as an outpatient procedure. PATIENTS AND METHODS: In all, 52 consecutive patients with recurrent papillary tumours of the bladder were scheduled for holmium:YAG laser vaporization under local anaesthesia using a flexible cystoscope. The number of papillomas and total operative duration was recorded. Patients and surgeons were asked to complete a questionnaire about the procedure. RESULTS: In all, 197 papillomas were successfully vaporized in 88 operations, with a median operative duration of 15 min (5 min per papilloma) and no patient needed treatment under general anaesthesia. Most patients (86%) had no pain (as reported during standard cystoscopy) and none of the procedures was stopped because of pain. All patients would undergo the treatment again, compared with a standard transurethral resection of bladder tumour. The five surgeons rated the procedure as easy in most patients (78%) and difficult in a few (6%). The total cost for the outpatient procedure was less than that for standard treatment. CONCLUSION: This study clearly indicates that holmium:YAG laser vaporization of superficial bladder tumours is feasible, easy and fast, with a high degree of patient satisfaction, and it seems to be an attractive alternative to standard treatment. The procedure has some clear positive socio-economic perspectives in both the short- and long-term.     

Early and large-dose intravesical instillation of epirubicin to prevent superficial bladder carcinoma recurrence after transurethral resection

OBJECTIVE: To prospectively compare the prevention of tumour recurrence by four intravesical adjuvant administration protocols, and thus elucidate the efficacy of early and high total dose instillations of epirubicin to prevent superficial bladder tumour recurrence after transurethral resection of bladder tumour (TURBT). PATIENTS AND METHODS: In all, 69 patients with Ta/T1 bladder cancer were randomly assigned to four intravesical administration protocols: A, delayed instillation (first instillation 7 days after TURBT) and low-dose (30 mg once every 2 weeks, six times): B, early instillation (three instillations before 7 days after TURBT) and low-dose; C, delayed and high-dose (30 mg once weekly 12 times) instillation; D, early and high-dose. The influence of the instillation protocols and tumour characteristics on the probability of recurrence-free survival was examined using Kaplan-Meier analysis and a Cox regression hazard model. RESULTS: The early-instillation and high-dose groups had relatively lower recurrence rates after 6 months (A, 30%; B, 25%; C, one of 12; and D, none) and 1 year (50%, 35%, four of nine and one of eight, respectively). Patients who received 360 mg epirubicin (C and D) had a significantly better recurrence-free survival than those receiving 180 mg (A and B; P = 0.012). Preoperative urine cytology and tumour multiplicity were significantly associated with recurrence. However, multivariate analysis of the risk of recurrence using a Cox proportional hazard model showed that urine cytology (hazard ratio 3.11, 95% confidence interval 1.08-8.94, P = 0.04) and total dose (0.32, 0.11-0.92, P = 0.03) were independent prognostic factors for recurrence. CONCLUSION: Patients who received a high-dose epirubicin instillation had a significantly lower recurrence rate but the benefit of early instillation was not confirmed, as the study group was too small.     

Analysis of prognostic factors related to primary superficial bladder cancer tumor recurrence in prophylactic intravesical epirubicin therapy

PURPOSE: The aims of the present study were to examine the effects of intravesical instillation of epirubicin on tumor recurrence and to identify tumors that are at a high risk of recurrence. METHODS: Forty-five patients with primary superficial bladder cancer were treated with prophylactic intravesical epirubicin following transurethral resection of the bladder tumor (TUR-BT). Epirubicin (20 mg) was administered intravesically every second week for 4 months and then once a month or every 2 weeks for next 8 months. Patients were analyzed with respect to prognostic factors related to tumor recurrence. RESULTS: The overall recurrence-free rate, calculated using the Kaplan-Meier method, was 76.1 and 52.3% at 2 and 5 years after operation, respectively. These results were better than those reported for patients treated with TUR-BT alone. A univariate analysis demonstrated that high-grade, T1, sessile, large (> or = 2 cm) and multiple tumors were a significantly high risk for recurrence. A multivariate analysis performed by using the Cox proportional hazard model with stepwise selection showed that morphologic features (pedunculated or sessile) were the most prognostic factors for recurrence. This was followed by age and tumor size. The remaining four factors were not found to contribute significantly to recurrence. CONCLUSIONS: Epirubicin appears to be effective in preventing the recurrence of superficial bladder cancer. Morphologic features, patient age and size of the tumor were considered independent risk factors. The risk of recurrence for each tumor should be taken into consideration when the intravesical adjuvant therapy protocol is being selected.     

表柔比星灌注预防浅表性膀胱癌术后复发

目的 评价表柔比星(EPI)膀胱内灌注预防浅表性膀胱癌术后复发的疗效和安全性。方法 对63例浅表性膀胱癌患者行经尿道膀胱肿瘤电切术(TuRBt)或膀胱部分切除术，术后定期应用EPl30mg(40mL)作膀胱内灌注，每周1次，共8次，以后每月1次，共1年。每次药物在膀胱内保留l小时。结果 经7～28月随访，平均15月，复发4例，复发率为6.3％，未见全身性药物不良反应，仅5例出现轻度膀胱刺激症状。结论 EPI膀胱内灌注预防浅表性膀胱癌术后复发疗效满意，副作用轻，耐受性良好。     

Ho:YAG激光治疗浅表性膀胱肿瘤的临床观察

目的 总结应用Ho:YAG激光治疗浅表性膀胱肿瘤的方法及疗效。方法 术前经膀胱镜，病理诊断为浅表性膀胱肿瘤患者52例。单发39例。多发13例，肿瘤共87个，经膀胱镜置入光纤，直视下应用脉冲式Ho:YAG激光切除，汽化膀胱肿瘤及基肿瘤基底周围膀胱粘膜。结果 52例中，9例局麻下门诊完成，术后未留置导尿管，43例留置导尿管1-3d。手术时间10-40min，平均25min，术后创面无瘤细胞残留，术中术后无出血，膀胱穿孔，闭孔神经反射等并发症，7例输尿管口肿瘤术后输尿管口无狭窄，输尿管无种植，50例术后随访3-31个月，6例复发，复发率12%。结论 Ho:YAG激光治疗膀胱肿瘤简单易行，无并发症，在治疗输尿管口肿瘤及常规电切镜不易达到的肿瘤具有优势，是治疗浅表性膀胱肿瘤的一种方法。     

膀胱内灌注盐酸表柔比星预防膀胱癌术后复发92例临床对照研究

目的研究盐酸表柔比星膀胱灌注预防经尿道膀胱癌电切术(TURBt)术后复发的疗效。方法对184例膀胱癌患者在TVRBt术后行膀胱灌注化疗,平均分成两组:Ⅰ组(92例)定期膀胱内灌注盐酸表柔比星,术后第1天使用50 mg,膀胱内灌注保留2 h,1周后开始常规灌注化疗,每周1次连续3次,然后每月1次连续11次,共1年;Ⅱ组(92例)为对照组灌注丝裂霉素40mg,灌注方法同Ⅰ组。结果随访10～46个月,平均(30±4)个月。复发率Ⅰ组为6.5%,Ⅱ组为17.4%,差异有统计学意义(P0.05);不良反应包括尿路刺激症状、肉眼血尿等,两组比较差异无统计学意义。结论 TURBt后早期膀胱内灌注盐酸表柔比星化疗,可以显著降低膀胱肿瘤复发率。     

TURBT联合膀胱内BCG灌注治疗肌层浸润性膀胱癌疗效分析

目的 探讨选择性经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBT)治疗经选择的肌层浸润性膀胱尿路上皮癌患者保留有功能性膀胱的可行性.方法 回顾性分析大连医科大学附属第二医院2006年至2011年间323例行TURBT治疗的膀胱尿路上皮癌患者的临床资料,选择术前影像学检查无明显膀胱外浸润,肿瘤单发,直径5 cm以下,局限于膀胱顶壁、底壁及侧壁,距输尿管口1 cm以上,不伴有原位癌,肿瘤创缘及基底部活检为阴性的T2期患者为研究对象,接受选择性TURBT伴膀胱内灌注BCG的保膀胱治疗.术后膀胱镜密切随访5~10年,运用统计学分析生存率、疾病特异生存率和无复发生存率评价疗效.结果 入组31例患者,5年总体生存率、疾病特异生存率和无复发生存率分别为87%、93%和58%.复发15例,浅表性复发6例,8例接受延迟膀胱癌根治术.23例保留有功能性膀胱,死亡6例.结论 选择性TURBT治疗肌层浸润性膀胱癌在少部分经严格选择的患者中是合理可行的,术后患者应终生接受膀胱镜严密随访.     

膀胱内不同化疗药物灌注预防浅表型膀胱肿瘤复发的临床观察

目的观察不同化疗药物膀胱内灌注预防浅表型膀胱肿瘤复发的疗效。方法将154例膀胱肿瘤术后患者分成表阿霉素组（EPI）、米托蒽醌组（MTZ）、吡柔比星组（THP）、丝裂霉素组（MMC）、羟基喜树碱组（HCTP），进行膀胱内灌注并随访观察3年。结果表阿霉素组、米托蒽醌组、吡柔比星组、丝裂霉素组、羟基喜树碱组无瘤生存率1年为80．6％（25／31），79．3％（23／29），80．6％（25／31），71．9％（23／32），71．0％（22／31）；2年为73．3％（22／30），72．4％（21／29），71．0％（22／31），64．5％（20／31），71．0％（22／31）；3年为60．0％（18／30），62．1％（18／29），61．3％（19／31），60％（18／30），61．3％（19／31）。结论五种药物膀胱内灌注预防浅表膀胱肿瘤复发3年无瘤生存率无显著性差异。