羟基喜树碱灌注预防膀胱癌术后复发的疗效观察

目的 观察羟基喜树碱灌注预防膀胱癌术后复发的疗效。方法 术后3年内用羟基喜树碱15～20 mg定期行膀胱灌注。结果 189例患者随访2.4～5年,复发24例,3年内总复发率为12.7％。结论 羟基喜树碱膀胱灌注预防膀胱癌术后复发疗效显著,无明显副作用,对预防切口种植的作用尚待进一步探讨。     

茶多酚诱导膀胱癌EJ细胞株凋亡与细胞内钙离子变化的相关性

目的：探讨茶多酚对膀胱癌EJ细胞株抑制增殖的分子机理。方法：采用流式细胞术、噻唑蓝(MTT)比色法和激光共聚焦成像技术，分别测定膀胱癌EJ细胞株的凋亡状态、细胞的周期变化、线粒体功能及细胞内离子钙浓度水平变化。用茶多酚处理EJ肿瘤细胞。结果：细胞的周期依浓度的改变而变化，浓度增加至20μg／ml发生明显的凋亡，OD值与浓度呈负相关性。细胞内钙离子浓度与时间、浓度的增加呈量效正相关。钙离子浓度逐渐升高亦呈现为时效、量效正相关性。结论：茶多酚能影响肿瘤细胞的增殖、凋亡过程。茶多酚诱导所致线粒体变化、细胞内钙离子超载可能在肿瘤凋亡中起着重要作用。     

人膀胱癌细胞nm23蛋白表达量与丝裂霉素抗药指数之间的相关性研究

目的探讨膀胱癌细胞nm23蛋白表达量与丝裂霉素药物敏感性之间的相关性.为临床膀胱移行细胞癌治疗方案选择提供理论依据.方法对32例临床病理诊断为膀胱移行细胞癌标本采用S-P免疫组化和图像分析技术检测细胞的nm23蛋白表达量;同时采用MTT法测定膀胱癌细胞对丝裂霉素的药物敏感性.结果膀胱癌nm23表达量与MMC抗药指数相关,相关指数为0.890(P＜0.001).结论膀胱癌nm23蛋白表达量与MMC抗药指数呈正相关.     

Stomach versus sigmoid colon in children undergoing major reconstruction of the lower urinary tract

A review of 50 patients who underwent intestinocystoplasty (ICP) or gastrocystoplasty (GCP) replacement at our department during an 8-year period is presented. The most common diagnoses were neurogenic bladder and bladder exstrophy. A total of 48 patients underwent augmentation cystoplasty and 2 had total bladder replacement. Mean follow-up time was 42 months. The clinical and metabolic aspects of the two types of ICP are reported. Hyperchloremic acidosis requiring therapy was not encountered, although mild degrees were seen after sigmoid augmentation in 36% of patients. A dysuria-hematuria syndrome (DHS) was seen in 50% of the patients who underwent GCP. Operative mortality rate was nil. Significant surgical complications occurred in 36% of the patients. The overall success rate for ICP and GCP in this series was 79.15%. ICP gives effective results when used to increase the compliance of the lower urinary tract, but problems related to electrolyte absorption, stones, and mucus production are often encountered. In GCP electrolyte absorption is practically eliminated, so that this technique can be used in patients with renal damage. In addition, patients with a normal bladder plate (bladder exstrophy) can achieve normal voiding with time. The authors believe that patients must be made aware of the possibility of DHS and that this syndrome needs further investigation.     

Application of the Mitrofanoff principle in children with severe impairment of bladder function

Treatment of children with severe impairment of bladder function requires a large-volume, low-pressure reservoir combined with a continent, easily catheterizable valve. The Mitrofanoff principle (MP) appears to meet these requirements.Between 1986 and 1993, the MP was applied in 15 children (4 girls) aged 4 to 14 years. The primary diagnosis was bladder exstrophy in 8 (2 girls), neuropathic bladder in 3 (2 girls), urethral valves in 2, and rhabdomyosarcoma (RMS) in 2. In 10 patients bladder augmentation with an intestinal patch was performed in addition to a Mitrofanoff procedure; in 5 a neobladder and continent appendicostomy were made. One boy with RMS died of distant metastases with a well-functioning appendicostomy and adequate renal function. At 2 to 9 years follow-up of the other 14 patients, 12 have a good result defined as: (1) adequate reservoir capacity; (2) continence; (3) normal renal function; and (4) no hydronephrosis. In 1 exstrophy patient with preexisting impairment of renal function, further deterioration necessitated frequent catheterization and additional medical treatment. In I boy with fulgurated urethral valves, spontaneous micturition became subsequently possible, allowing closure of his appendicovesicostomy. Complications occurred in 10 patients, necessitating reintervention in 7. The MP in combination with the creation of an adequate reservoir gives good results in children with severe impairment of bladder function. Careful attention should be given to patient education regarding emptying of the reservoir. Long-term follow-up of renal function is mandatory.     

Bladder tissue pharmacokinetics of intravesical taxol

Our previous studies have suggested that the ineffectiveness of intravesical mitomycin C or doxorubicin therapy against muscle-invading bladder cancer is in part because of the inability of these drugs to penetrate the urothelium (the urothelial drug concentration is <5% of the concentration in urine). The goal of the present study was to identify agents that are efficiently absorbed across the urothelium. To evaluate the potential use of taxol in intravesical therapy for bladder cancer, we examined the bladder tissue and systemic plasma pharmacokinetics of intravesical taxol in dogs. Animals (∼8 kg body weight) were given an instillation of taxol at 500 μg in 20 ml water. At 120 min postinstillation, the bladder was emptied and excised, and about 85% of the dose was recovered in the urine. The taxol concentration in the urothelium was about 50% of the concentration in the urine, the concentrations then declined logarithmically in the underlying capillary-perfused tissues. The average tissue concentration (∼2 μg/g) was two to three times the reported plasma concentration of 0.75 μg/ml in patients following intravenous infusion of the >100-fold higher dose of 250 mg/m². The steady-state plasma concentration was <0.02% of the average tissue concentration, and was <0.05% of the maximally tolerated plasma concentration in patients. The octanol:water partitioning coefficients of taxol, doxorubicin, and mitomycin were >99, 0.52, and 0.41, which parallels the rank order of the partitioning across urothelium, i.e. taxol (∼50%) >> doxorubicin ≈ mitomycin C (∼3%). In summary, the partitioning of taxol across the urothelium was more favorable than the partitioning of mitomycin C and doxorubicin, and the systemic concentration of taxol resulting from intravesical treatment was insignificant in spite of the extensive absorption into the bladder. We conclude that intravesical delivery of taxol provides a significant bladder tissue targeting advantage, and that taxol represents a viable candidate drug for intravesical bladder cancer therapy. Received: 20 September 1996 / Accepted: 2 December 1996     

Feasibility trial of high-dose 7-day continuous-infusion ifosfamide given on an outpatient basis

 High-dose ifosfamide (HD-IFX) has shown significant antitumor activity in advanced sarcoma and breast carcinoma. The use of uroprotective agents and the availability of ambulatory continuous-infusion pumps has allowed dose escalation in the administration of ifosfamide (IFX) on an outpatient schedule. We report the results of a phase II trial of IFX given at high doses to heavily pretreated patients. IFX was infused at 2 g/m² per day for a total of 7 days through a central venous access, with cycles being repeated every 21 days. Mesna was given concomitantly at equimolar doses. No hematopoietic support was used. A total of 27 heavily pretreated patients whose disease had progressed during conventional-dose chemotherapy were included (14 sarcomas, 10 breast carcinomas, and 3 bladder carcinomas). Reversible neutropenia and gastrointestinal toxicity were the most frequently encountered toxicities. Only two patients developed transient renal failure, and two others developed central nervous system toxicity. No treatment-related death was observed. Of 22 patients who were evaluable for response, 6 (27%) showed an objective response (OR), all ORs being partial responses (PRs) with a median duration of 6 months, and 12 patients had stable disease (SD; 55%) with a median duration of 3.5 months. The median overall survival (OS) was 6 months. Three patients underwent high-dose chemotherapy after showing a response to our IFX schedule. We conclude that continuous-infusion IFX given in an outpatient setting is a feasible and active regimen that produces, a manageable toxicity profile in heavily pretreated breast cancer and sarcoma patients. Early institution of this schedule in less advanced stages could improve the results obtained. Received: 30 June 1996 / Accepted: 20 January 1997     

再次尿道成形术治疗先天性尿道下裂术后严重并发症

目的：了解先天性尿道下裂行各种尿道成形术失败后，利用膀胱粘膜行尿道成形术的疗效。方法：将严重狭窄和（或）无法修补的尿瘘瘢痕组织彻底切除，取膀胱粘膜片形成尿道，正位开口于龟头，新尿道内置多孔硅胶支架管作引流。结果：２８例中，２３例治愈，３例有小尿瘘需作尿瘘修补，２例完全失败，再次作粘膜尿道成形术治愈。结论：各种类型先天性尿道下裂尿道成形失败后，可用膀胱粘膜移植尿道成形，效果良好     

多型别人乳头瘤病毒在膀胱癌中的表达

目的：探讨人乳头瘤病毒与泌尿系肿瘤关系。方法：用ＰＣＲ检测５０例膀胱癌组织中人乳头瘤病毒的感染情况。结果：ＨＰＶ１６、１８型检测阳性率１０％，ＨＰＶ通用型（即６、１１、１６、１８、３１、３３）检测阳性率６０％。其感染与病理分级无关。结论：多型别混合感染是膀胱癌的病因之一     

高能聚焦超声对皮下移植性膀胱肿瘤治疗的初步观察

目的：研究高能聚焦超声（ＨＩＦＵ）辐射治疗对小鼠皮下移植肿瘤的可行性。方法：采用已建立的小鼠皮下可移植性膀胱肿瘤模型，用国内研制的ＨＩＦＵ仪对皮下荷瘤鼠进行了实验研究。实验分为：治疗组小鼠４５只，采用超声强度７００Ｗ／ｃｍ２的ＨＩＦＵ对小鼠皮下移植瘤进行辐照治疗；对照组小鼠４５只，不采用任何处理。观察治疗后荷瘤鼠生存时间，生长曲线，以及治疗后靶组织的光镜、电镜下改变。结果：平均生存时间：治疗组３７．２０±８．２２天，对照组１４．０７±２．４６天（Ｐ＜０．０１）。ＨＩＦＵ治疗后肿瘤组织呈灰白色，治疗区皮肤无灼伤，治疗后３ｈ，靶区瘤细胞肿胀，并可见点状坏死，１周时出现了边界清楚的凝固性坏死区。结论：ＨＩＦＵ可以明显抑制移植性膀胱肿瘤