减少肾盂癌术后再发膀胱癌的临床研究

目的 探讨减少肾盂癌术后再发膀胱癌的方法.方法 回顾性分析1997年10月至2007年12月收治并获随访的227例肾盂癌患者.男性126例,女性101例,年龄34～78岁.全程肉眼血尿176例,腰部疼痛51例.采用两种方法分离患侧管口周围膀胱壁.A方法:沿患侧输尿管分离至膀胱壁;B方法:沿输精管向下分离患侧管口周围膀胱后壁并切断膀胱侧韧带达精囊部位.采用三种方法进行膀胱灌注化疗.方法 1:术后当天开始每周灌注1次,共10次;方法2:术后当天灌注1次,3周后每周灌注1次,共10次;方法3:术后3周开始每周灌注1次,共10次.术后定期膀胱镜检查,随访1～10年.采用χ2检验和Logistic回归对膀胱癌再发率进行分析.结果 术后膀胱癌再发率27.8%(63/227).采用方法A和方法B的患者患侧管口周围区域膀胱癌再发率分别为18.0%(7/39)和12.5%(3/24),两者相比较差异有统计学意义(P<0.05).膀胱灌注化疗方法1、2、3的膀胱癌再发率分别为17.9%(11/67)、20.8%(10/48)、33.3%(17/51),方法1与方法3相比较差异有统计学意义(P<0.05).结论 充分分离确切切除患侧管口周围膀胱黏膜,术后当日开始每周1次膀胱灌注化疗是减少肾盂癌术后再发膀胱癌的有效方法.

The clinical study for reducing bladder cancer recurrence after surgical treatment for renal pelvic carcinoma

Objective To investigate the clinical methods for reducing bladder cancer recurrence after surgical treatment for renal pelvic carcinoma. Methods From October 1997 to December 2007, the data of 227 patients undergoing total nephroureteretomy for clinically localized transitional cell carcinoma of the renal pelvis with follow-up results were analyzed retrospectively, including 126 cases of male and 101 cases of female, and the age was 34 to 78 years old. There were 2 kinds of technique used in the dissection of bladder wall circumferentially around the ureteral orifice. Technique A was dissection along the ipsilateral ureter to the bladder wall. Technique B was dissection along the vas deferens to the bladder wall circumferentially around the ipsilateral ureteral orifice and division of the lateral vesical ligament to reach the seminal vesicle. Prophylactic intravesical chemotherapy included 3 method. Method 1 was intraoperative intravesical chemotherapy and then administrated once a week, 10 times in total. Method 2 was intraoperative intravesical chemotherapy and then administrated once a week from the 4th week after operation, 10 times in total. Method 3 was intravesical chemotherapy was given once a week from the 4th week after operation, 10 times in total. The time of follow-up was 1 to 10 years with regular cystoscopy. Chi-square test and Logistic regression were used to analyzed the recurrence rate of bladder cancer. ResultsRecurrence rate of bladder cancer was 27.8% (63/227). The recurrence rates of bladder cancer in patients using technique A and B were 18.0% (7/39) and 12.5% (3/24), respectively (P<0.05). The postoperative recurrence rates of bladder cancer in patients using 3 kinds of intravesical chemotherapy regimen were 17.9% (11/67), 20.8% (10/48) and 33.3% (17/51), respectively. There was significant difference between the recurrence rates of patients using method 1 and method 3 intravesical chemotherapy (P<0.05). Conclusion Complete removal of the bladder mucosa circumferentially around the ureteral orifice, administration of the intraoperative intravesical chemotherapy instillation and instillation once a week may be a useful approach to reduce the recurrence of bladder cancer after operation for renal pelvic carcinoma.