丝裂霉素C诱导式卡介苗膀胱灌注预防膀胱肿瘤术后复发的临床研究

【目的】探讨丝裂霉素C（MMC）诱导式卡介苗（BCG）膀胱灌注预防膀胱肿瘤术后复发的疗效及可行性。【方法143例非浸润性尿路上皮癌患者行经尿道膀胱肿瘤电切术（TuRBt）术后分为两组：MMC诱导式BCG组22例（观察组）,术后即刻行MMC膀胱单次灌注,第2周后开始定期行膀胱灌注BCG;单纯BCG组21例（对照组）,TURBt术后第2周开始灌注BCG,并定期进行灌注治疗。两组均定期行膀胱镜检查、尿脱落细胞学检查和随访。【结果]43例术后随访24个月,对照组3例分别于术后2,3,11个月复发,复发率14．3％（3／21）,其余18例未见复发;观察组未见复发病例,两组比较差异有显著性（P〈0．05）。两组均没有严重不良反应和并发症发生。【结论]MMC即刻单次膀胱灌注联合BCG定期膀胱灌注的免疫化学疗法对预防非浸润性膀胱尿路上皮癌术后复发疗效好,不良反应不明显,有较好的临床应用价值。

Clinical Study of Mitomycin C-induced Intravesical Instillation of BCG for Preventing the Postoperative Recurrence of Bladder Carcinoma

[Objective]To evaluate the efficacy and feasibility of mitomycin C （MMC）-induced intravesical instillation of Bacillus Calmette-Guerin（BCG） for preventing the recurrence of non-invasive urothelial carcinoma of human bladder after transurethrai resection of bladder tumor（TURBt）. [MethodslA total of 43 non-in- vasive urothelial carcinoma patients who underwent TURBt were divided into two groups. MMC-induced intravesical instillation of BCG group（ n =22） received single intravesical instillation of MMC instantly during surgery and regular intravesical instillation of BCG since 2 weeks after operation. BCG group（ n = 21） only received regular intravesical instillation of BCG since 2 weeks after operation. All patients were followed up for 24 months. [Results]Three patients had recurrence at 2, 3 and 11 months after operation individually in BCG group. No recurrence developed in MMC-induced intravesical instillation of BCG group. The recurrence rate was significantly higher in BCG group than that in MMC-induced intravesical instillation of BCG group（14.3 vs. 0, P d0.05）. No serious adverse event and complication developed in both groups. [Conclusion] Intravesical instillation of MMC instantly during surgery plus subsequent regular intravesical instillation of BCG is markedly effective for preventing postoperative recurrence of non-invasive urothelial carcinoma of human bladder with few adverse events.