吡柔比星膀胱灌注后膀胱黏膜脱落2例并文献复习

目的：总结分析2例吡柔比星膀胱灌注后罕见并发症的发生，提高对吡柔比星膀胱灌注药物不良反应的认识。方法：回顾性分析2例吡柔比星膀胱灌注患者的临床资料。结果：在2例患者的治疗当中，常规抗感染、解痉治疗效果不佳，镜检发现片状膀胱黏膜剥脱并局部渍疡，病检证实为膀胱黏膜慢性炎症伴溃疡，予膀胱黏膜电灼、溃疡电切后辅以激素膀胱灌注、口服激素等约1周后好转。结论：吡柔比星膀胱灌注会导致膀胱黏膜脱落，这可能与黏膜破坏后的局部变态反应有关，行膀胱黏膜电灼、溃疡电切后激素治疗有效。著者文摘]

Two cases of defluxion of urinary bladder mucous membrane after intravesical instillation of pirarubicin

【Abstract】Objective To explore 2 cases of rare complication and to improve the congnition of drug adverse reaction after intravesical instillation of pirarubicin.Methods To summarize 2 cases with intravesical instillation of pirarubicin. Case 1 is female, 59, who recept the transurethral electroresection because of　bladder cancer. After the operation, 20mg pirarubicin was used for irrigation of bladder in routin way. 5 times later, the serious irritation sign of bladder emerged. At the same time, we found the defluxion of urinary bladder mucous membrane; Case 2 is also female, 35, who recept the transurethral electroresection too. Then 30mg pirarubicin was used for irrigation of bladder in routin way. 7 times later, irritation sign of bladder appeared exacerbation. So another transurethral electroresection was executing. But not long after a 3 more same intravesical instillation, the same condition as the case 1 occurred. At first anti-infection and spasmolysis was performed,but there was no effect. Then the operation was executing: the mucous membrane of urinary bladder was fulgerizing, and the ulcer was electroresected. On the other hand, Dexamethasone 10mg and 2% Lidocaine 20ml was used for intravesical instillation once a day. Simultaneously,5mg Prednisone was taken orally twice a day.Results The routin therapy, such as anti-infection, spasmolysis,has poor effect. We found the mucosal abrasion and ulcer through cystoscope. It was proved that there was chronic systitis accompaly with ulcer by pathology. After the operation and the drug treatment for about a week,the two cases recovered from illness. Conclusions Intravesical instillation of pirarubicin could result in the defluxion of urinary bladder mucous membrane, which maybe associated with allergy. It is effective after the fulguration and the electrotomy corresponding with hormonal therapy.