等离子电切剜除联合吉西他滨局部灌注治疗浅表膀胱癌的效果分析

目的观察采用改进的等离子电切剜除术联合吉西他滨膀胱灌注治疗浅表膀胱癌的效果。方法选择陆军军医大学第一附属医院和黔南州人民医院2015年1月至2017年12月行经尿道膀胱肿瘤内镜切除术的浅表膀胱癌患者60例,随机分为传统电切联合表柔比星膀胱灌注治疗组(对照组)和改进的等离子剜除术联合吉西他滨灌注治疗组(观察组),每组30例。术中行肿瘤切缘活检,阳性患者需行二次电切,观察2组患者围手术期并发症的差异,定期行膀胱灌注化疗2年并密切随访,对比2组患者在肿瘤复发率和远期不良反应方面的区别。结果观察组患者切缘阳性率低于对照组,差异具有统计学意义(P<0.05);2组患者围手术期并发症比较,差异无统计学意义(P>0.05);2组患者术后1年复发率差异无统计学意义(P>0.05);但观察组术后2年的累积复发率低于对照组,差异有统计学意义(P<0.05),而且观察组患者的血尿和会阴疼痛发生率明显低于对照组,差异有统计学意义(P<0.05)。结论浅表膀胱癌采用等离子剜除联合吉西他滨局部灌注化疗具有很好的临床疗效,相比传统的电切联合表柔比星灌注疗效果更佳,且不良反应少,安全性更高。

Efficacy analysis of plasma electrosurgical excision combined with gemcitabine local perfusion for superficial bladder cancer

Objective To observe the curative effect of modified plasma electrosurgical excision combined with bladder infusion of gemcitabine for superficial bladder cancer.Methods A total of 60 patients with superficial bladder cancer who were admitted into the First Affiliated Hospital of Army Medical University and Qiannan People′s Hospital from January 2015 to December 2017 were selected and randomly divided into the control group and the observation group,with 30 patients in each group.Patients of the control group were treated by conventional electrosurgical excision with epirubicin intravesical instillation,and patients of the observation group were treated by modified plasma enucleation with gemcitabine instillation.During the operation,the tumor margin biopsy was performed,and the positive patients need to undergo a second electric resection.The difference of perioperative complications between the two groups was observed,and regular intravesical instillation chemotherapy was performed for 2 years after operation.Patients of the two groups were followed up closely,and the differences of tumor recurrence rate and long-term adverse reactions between the two groups were compared.Results The positive rate of cutting edge in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in perioperative complications(P>0.05).There was no significant difference in recurrence rate between the two groups 1 year after operation(P>0.05),but there was significant difference in cumulative recurrence rate 2 years after operation(P<0.05).The incidence of hematuria and perineal pain in the observation group was significantly lower than those in the control group(P<0.05).Conclussion For superficial bladder cancer,plasma electrosurgical excision combined with gemcitabine local perfusion has a good clinical effect.It has better therapeutic effect,fewer adverse reaction and higher safety compared with the conventional electrosurgical excision with epirubicin intravesical instillation.