围手术期吡柔比星膀胱灌注预防非肌层浸润性膀胱癌术后复发的对照研究

目的评价围手术期吡柔比星膀胱灌注预防非肌层浸润性膀胱癌术后复发的疗效。方法将80例经尿道膀胱肿瘤电切术(TUR-BT)治疗的非肌层浸润性膀胱癌患者随机分为两组。治疗组38例,应用吡柔比星30 mg+5%葡萄糖40 ml,术前30 min膀胱灌注,而后行TUR-BT;术后24 h内吡柔比星40 mg+5%葡萄糖40 ml即刻灌注1次,此后1次/周,共8周;而后1次/月,至术后1年。对照组42例,TUR-BT术后2周开始行吡柔比星40 mg+5%葡萄糖40 ml膀胱灌注,1次/周,共8周;而后1次/月,至术后1年。所有患者术后均随访2年,行尿常规、尿脱落细胞、泌尿系彩超、静脉肾盂造影、膀胱镜检查等观察肿瘤有无复发。结果 80例患者均获得随访,其中治疗组复发1例,复发率2.6%;对照组复发8例,复发率19.0%。两组复发率相比差异有统计学意义(P0.05)。术后可见血尿6例(治疗组3例,对照组3例),尿道刺激征5例(治疗组3例,对照组2例),尿道狭窄2例(治疗组1例,对照组1例)。复发患者多为膀胱多发肿瘤,而且肿瘤直径多大于2.5 cm,复发时间在8~15个月之间。结论围手术期吡柔比星膀胱灌注有助于确定肿瘤范围,指导手术治疗,并减少残存肿瘤种植,是预防非肌层浸润性膀胱癌术后复发的有效方案。

A comparative study of intravesical instillation of pirarubicin during perioperative period for preventing postoperative recurrence of non muscle - invasive bladder cancer.

Objective To evaluate the efficacy of intravesical instillation of pirarubicin during perioperative period for preventing postoper- ative recurrence of non muscle - invasive bladder cancer. Methods A total of 80 cases of non muscle - invasive bladder cancer were randomly di- vided into two groups. TUR - BT therapy was performed in all patients. 30 minutes before the operation, pirarubicin perfusion （40 ml of 30 mg ＋ 5% GS） was performed in the treatment group（38 cases）. Then, pirarubicin perfusion （40 ml of 40 mg ＋ 5% GS） was given within 24 hours after operation. Then the patient was given once a week for 8 weeks. And then the patient was given once a month to 1 year after operation. The control group （42 cases） was given after 2 week of operation,then given once a week for 8 weeks. And then the patient was given once a month to 1 year after operation. Results All cases received 24 months follow - - up. In the treatment group, one patient recurred during the follow - up period. The recurrence rate was 2.6%. In the control group, 8 cases recurred. The recurrence rate of this group was 19.0%. Adverse reactions were mainly urinary tract irritation, hematuria and urethral stricture. Conclusion This study showed that intravesical instillation of pirarubicin during perioperative period for preventing postoperative recurrence of non muscle - invasive bladder cancer was effective.