术后单次与多次膀胱灌注丝裂霉素C预防非肌层浸润性膀胱癌复发的效果比较

目的比较非肌层浸润性膀胱癌行经尿道膀胱肿瘤电切术（transurethral resection of bladder tumors,TURBT）术后即刻单次与术后1周开始多次膀胱灌注丝裂霉素C预防非肌层浸润性膀胱癌复发的效果。方法将67例行TURBT术术后的非肌层浸润性膀胱癌患者按随机数字表法分为2组。单次灌注组34例,采用丝裂霉素C 40 mg加入生理盐水40 mL中行TURBT术术后即刻膀胱灌注,共1次。多次灌注组33例,采用丝裂霉素C40 mg加入生理盐水40 mL中在TURBT术术后1周行膀胱灌注,每周1次,共8次。随后每个月1次,共22次。观察2组患者术后3年非肌层浸润性膀胱癌的复发,以及病理学分级为G1、G2＋G3非肌层浸润性膀胱癌的复发等情况。结果单次灌注组、多次灌注组术后3年复发率分别为44.1%、30.3%,2组比较差异无统计学意义（P〉0.05）。单次灌注组、多次灌注组病理学分级为G1复发率分别为18.8%、29.4%,2组比较差异无统计学意义（P〉0.05）;单次灌注组、多次灌注组病理学分级为G2＋G3复发率分别为66.7%、31.3%,2组比较差异有统计学意义（P〈0.05）。结论单次灌注组与多次灌注组预防非肌层浸润性膀胱癌复发的总体效果相当。但对于病理学分级（G2＋G3）较高的非肌层浸润性膀胱癌,多次灌注比单次灌注能更好的减少术后复发。

A Comparative Effects of Single and Multiple Intravesical Instillation of Mitomycin C Postoperative for Preventing the Recurrence of Non-muscle Invasive Bladder Cancer

Objective To comparative the curative effect of single Mitomycin C （MMC） intra- vesical instillation instantly postoperative transurethral resection of bladder tumors（TURBT） and multiple MMC intravesical instillations starting from 1 week after TURBT for preventing the non-muscle invasive bladder cancer recurrence. Methods 67 patients of TURBT postoperative with non-muscle invasive bladder cancer according to random number table method were divided into 2 groups. Single instillation group containing 34 cases received single intravesical instillation of 40 mg MMC adding 40 mL of normal saline immediately postoperative TURBT. Multiple instillation group containing 33 cases received multiple intravesical instillations of 40 mg MMC adding 40 mL of normal saline, which started from 1 week postoperative TURBT, at the frequency of once a week in the first 8 weeks, and then turned into once 1 times for the remaining 22 months. Observed two groups patients recurrence of non-muscle invasive bladder cancer postoperative in 3 years and furthermore, between different pathological grades （G1, G2 ＋ G3 ） non-muscle invasive bladder cancer recurrence etc. Results The recurrence rates were 44. 1% in single instillation group and 30.3 % in multiple instillation group in the postoperative 3 years. There was no significant difference between these two groups （P〈0.05）. The recurrence rates in low grade of the tumor （G2） were 18.8% in single instillation group and 29.4% in multiple instillation group. There was no significant difference between these two groups （P〈0.05）. The recurrence rates in higher grades of the tumor （G2 and G3） were 66.7% in single instillation group and 31.3% in multiple instillation group . There was statistical significance between these two groups （P〈 0.05）. Conclusion The total curative effects quite of the mutiple MMC instillations for prevention the recurrence of non-muscle invasive bladder cancer were similar to the single MMC instilla- tion. However, multiple instillations compare single instillations may better reduce the recurrence of non-muscle invasive bladder cancer at higher pathological grades （G2 ＋G3）.