膀胱内灌注纤维蛋白溶解抑制药物对卡介苗抗膀胱癌复发作用影响的临床研究

目的探讨膀胱内灌注纤维蛋白溶解抑制药物增强卡介苗（BCG）预防膀胱癌术后复发的疗效。方法将208例浅表性膀胱移行细胞癌（BTCC）患者术后随机分成5组，A组44例，定期膀胱内灌注BCG100～120mg＋氨甲苯酸（PAMBA）0．1g＋生理盐水，B组4l例，灌注BCG50～60mg＋PAMBA0.1g＋生理盐水，C组4l例，灌注BCG100～120mg＋氨基己酸（EACA）2．0g＋生理盐水，D组39例，灌注BCG50～60mg＋EACA2．0g＋生理盐水，E组43例，灌注BCG100～120mg＋生理盐水。每周1次，6次后每月1次。灌注后每3个月作膀胱镜检查，必要时取活检明确肿瘤有无复发。结果随访4～58个月，平均22个月，A～E组BTCC复发率分别为10．3％、8．6％、9．7％、9．7％和29．7％。A、B、C、D各组抗BTCC复发的疗效均明显优于E组（对照组），差异有统计学意义（P〈0．05）；B、D组预防BTCC术后复发的效果与A、C组比较差异无统计学意义。结论膀胱内灌注纤维蛋白溶解抑制药物PAMBA、EACA可增强BCG预防膀胱癌术后复发的疗效，BCG剂量减半后，疗效不降低。

Clinical study on the effect of intravesical instillation of antifibrinolytic agents with bacillus Calmette-Guerin in preventing bladder cancer recurrence

Objective To study the effect of intravesical instillation of antifibrinolytic agents with bacillus Calmette-Guerin(BCG) in preventing recurrence of superficial bladder transitional cell carcinoma(BTCC) after surgical management.Methods A total of 208 cases of superficial BTCC who underwent transurethral resection of bladder tumor(TURBt) or partial cystectomy were divided into 5 groups.Then different doses of BCG with or without antifibrinolytic agents plus NS were regularly instilled into bladders(once a week,6 weeks later once a month).Group A(44 cases) received intravesical instillation of 100-120 mg BCG plus 100mg para-aminomethyl benzoic acid(PAMBA);group B(41 cases),instillation of(50-)60 mg BCG plus 100 mg PAMBA;group C(41 cases),100-120 mg BCG plus 2.0 g epsilon-aminocarproic acid(EACA);group D(39 cases),50-60 mg BCG plus 2.0 g EACA;and group E(controls,43 cases),100-120 mg BCG.Cystoscopy was performed every 3 months and side effects were monitored.All the cases were followed up for 4 to 58 months(mean,22.5 months). Results The rates of tumor recurrence of groups A,B,C and D(BCG plus antifibrinolytic agents intravesical instillation) were 10.26%,(8.57%),9.68% and 9.68%,respectively,which were significantly lower than that of group E(BCG instillation alone,29.73%)(P<0.05).And there was no significant difference of tumor recurrence rate between group A and group B or between group C and group D(groups A and C,with high dose of BCG;groups B and D,with low dose of BCG)(P>0.05).But the side effects occurred less frequently in groups B and D after BCG instillation than in groups A and C.Conclusions The efficacy of BCG in preventing recurrence of superficial BTCC can be enhanced by intravesical instillation of antifibrinolytic agents.Besides,BCG can be used at low dose with satisfactory effects.