低剂量丝裂霉素C术中肿瘤基底部注射加即刻灌注预防膀胱肿瘤复发

目的探讨低剂量丝裂霉素C（MMC）术中肿瘤基底部注射加即刻膀胱灌注对预防术后复发和进展的有效性及可行性。方法51例膀胱移行细胞癌初发病例，均接受保留膀胱手术；术中随机分成两组：A组（治疗组）27例，采用低剂量MMC（0．1g／L）术中肿瘤基底部注射，联合膀胱即刻灌注；B组（对照组）24例仅术后采取MMC（0．4g／L）定期膀胱内灌注治疗。术后随访12—60个月，比较两组复发率（RR）及进展率（PR），并分析其与初发肿瘤分期、分级的关系。结果A组复发3例，平均复发时间15．67个月，RR11．11％（3／27），B组复发9例，平均复发时间11个月，RR为37．50％（9／24），两组间复发率比较差异有显著性（P〈0．05）；两组复发肿瘤细胞病理分级升高共4例，其中A组病理由Gz升高至G2 1例；B组G1升高至G2 1例，由G2升高至G3 2例，相互比较差异无统计学意义（P〉0．05）；两组中共有9例发生肌层浸润进展，其中B组3例，浸润至膀胱浅肌层的T2期；A组1例，B组5例，浸润至深肌层的T3期，两组间分期PR比较差异有显著性（P〈0．05）；治疗期间，共有26例发生局部反应，未见膀胱黏膜坏死、骨髓抑制等严重并发症。结论低剂量MMC（0．10g／L）术中肿瘤基底部注射联合即刻膀胱灌注，对预防膀胱肿瘤术后复发及抑制肿瘤分期进展疗效均明显优于单纯MMC术后定期膀胱灌注治疗，且安全、可靠，尤其适用于低中风险的Ta或T1期的膀胱肿瘤患者，为T2或T3期的膀胱肿瘤患者增加了保留膀胱的治疗机会，可作为治疗膀胱肿瘤的较为理想的方法。

Low dose mitomycin C for preventing the recurrence of bladder carcinoma

Objective To evaluate the efficacy and feasibility of low dose Mitomycin C （MMC） for preventing recurrence and progression of bladder tumour by injecting into the tumour base plus perfusing inside bladder instantly during surgery. Methods A toal of 51 cases which had initial bladder transitional cell cancer were all treated with bladder-sparing surgery. The overall cases were divided randomly into two groups： Group A of 27 cases （therapy group） was treated by injecting low dose MMC （0.1 g/L） into the tumour base and perfusing inside bladder instantly during surgery, then perfusing MMC （0.4 g/L） regularly inside bladder postoperatively; Group B of 24 cases （control group） was only perfused regularly inside bladder after surgery. Follow-up lasted for 12 to 60 months. The recurrence rate （RR） and progression rate （PR） in the two groups were compared, and their association with the original tumour stage and grade was analyzed retrospectively. Results Relapse occurred in 3 cases of Group A, and 9 cases of Group B, the RR was 11.11% （3/27）, and 37.50% （9/24）, P〈0. 05. The pathology grades progressed in 4 recurrent cases, 1 case progressed from G2 to G3 in Group A. 3 cases progressed in Group B, 1 case from G1 to G2, 2 cases from G2 to G3, P〉0. 05. In all cases, 9 cases had muscle-invasion, 3 cases of Group B infiltrated to T2, 1 case of Group A and 5 cases of Group B infiltrated to T3, P〈0. 05. In treatment period, 26 of all cases had the partial response, but all cases had not any serious complication. Conclusion The curative effect of injecting low dose MMC （0.10 g/L） into the tumour base plus perfusing inside bladder instantly is better than perfusing MMC （0.4 g/L） regularly inside bladder alone after operation. It is more safe, reliable and suitable, especially for patients with bladder tumor of Ta and T1, and can provide the chance of bladder-sparing surgery for patients with bladder tumor of T2 and T3 .