吡柔比星对膀胱原位癌定位诊断价值的初步探讨

目的 初步探讨吡柔比星(THP)对于伴随膀胱肿瘤的膀胱原位癌的定位诊断价值.方法 灌注前将50 mg THP溶解于50 ml 5%葡萄糖溶液,对上海交通大学泌尿外科研究所2007年12月至2008年6月收治的51例非肌层浸润性膀胱肿瘤患者和14例无痛性血尿患者行THP膀胱灌注,保留15 min后置入膀胱镜检查,观察肿瘤组织及周围膀胱黏膜染色情况.非肌层浸润性膀胱肿瘤患者检查后行经尿道膀胱肿瘤激光切除术.对肿瘤组织、THP染色区域全部进行组织学检查,肿瘤蒂旁2 cm处及膀胱其他部位非染色区域组织作为随机对照,分析比较染色结果.结果 共37例膀胱肿瘤患者的67块肿瘤周围膀胱黏膜THP染色阳性,其中11块病理证实为膀胱原位癌,分布在7例患者中.14例无痛性血尿患者中有2例膀胱黏膜呈现THP染色阳性,其中1例染色区病理证实为膀胱原位癌;另外12例未染色,组织学检查无阳性发现.膀胱原位癌细胞吸收THP的敏感度和特异度分别为92.3%(12/13)和86.7%(371/428).结论 THP对于伴随膀胱肿瘤的膀胱原位癌诊断操作简便、直观,有一定的定位诊断价值.

Localization diagnosis of carcinoma in situ of bladder cancer by pirarubicin: preliminary clinical experience

Objective To investigate whether the location of carcinoma in situ (CIS) of bladder cancer could be macroscopically ascertained by instilling pirarubicin (THP) into urinary bladder. Methods 50 mg of THP was dissolved into 50 ml of 5% glucose solution. And the resulting solution was instilled into urinary bladder. After 15 min, the urinary bladder was observed by a cystoscopy. The study group consisted of 51 patients with bladder cancer (37 males, 14 females) and 14 patients with hematuria (8 males, 6 females) , treated at our hospital from December 2007 to June 2008. Results The THP uptake was seen in 67 flat (non-tumorous) areas of bladder mucosa in 37 patients with bladder cancer. Of these, 11 lesions in 7 patients were confirmed to be CIS. The THP uptake was found in 2 flat (non-tumorous) areas of bladder mucosa in 14 patients with hematuria, 1 lesion in 1 patient was confirmed to be CIS. The sensitivity and specificity of THP uptake by CIS were 92. 3% (12/13) and 86. 7% (371/428) respectively. Conclusion This practical method may be employed to ascertain easily the macroscopic location of CIS of bladder caner.