经尿道电切术联合膀胱灌注化疗在老年膀胱癌患者中的应用研究

目的 探讨经尿道电切术(TUR)联合膀胱灌注化疗在老年膀胱癌患者中的应用效果.方法 选择老年膀胱癌患者118例,根据医师介绍、患者自愿的原则将患者分为观察组与对照组,每组59例,观察组患者行TUR联合膀胱灌注化疗,对照组患者行根治性膀胱切除术.观察并比较两组患者术前及术后1周血清血管内皮细胞生长因子(VEGF)、血清胰岛素样生长因子-1(IGF-1)、尿液膀胱癌特异性核基质蛋白-4(BLCA-4)、炎性因子、免疫因子水平的差值,并对两组患者的术后不良反应发生率及1~2年生存情况进行比较.结果 两组患者术前与术后1周血清VEGF、血清IGF-1、尿液BLCA-4水平的差值比较,差异均无统计学意义(P﹥0.05).观察组患者术前与术后1周CRP、IL-6、TNF-α水平的差值均明显低于对照组(P﹤0.01).观察组患者术前与术后1周CD3+CD4+、CD3+CD8+、CD4+/CD8+水平的差值均明显高于对照组(P﹤0.01).观察组患者的术后总不良反应发生率明显低于对照组(P﹤0.01);观察组患者的术后1年、2年无瘤生存率和总生存率均高于对照组(P﹤0.05).结论 TUR联合膀胱灌注化疗治疗老年膀胱癌可有效清除恶性肿瘤细胞,纠正免疫失衡,且创伤小,有利于患者转归.

Application of transurethral resection combined with bladder perfusion chemotherapy in elderly bladder cancer patients

Objective To investigate the efficacy of the combination therapeutic regimen of transurethral resection (TUR) and bladder perfusion chemotherapy on elderly bladder cancer patients.Method One hundred and eighteen elder-ly patients with bladder cancer were enrolled,after introduction from doctors,divided into the observation group (59 cas-es) and the control group (59 cases) in accordance with the principle of voluntary.Patients in the observation group were treated with TUR and bladder perfusion chemotherapy,and patients in the control group were treated by radical cystecto-my.The different levels of serum vascular endothelial growth factor (VEGF),insulin-like growth factor-1 (IGF-1),blad-der cancer-associated nuclear matrix protein-4 (BLCA-4),inflammatory factors and immune factors before and after 1 week were observed and compared in all patients.The rates of postoperative complications,and survival after 1-2 years between two groups were compared.Result There was no significant difference in serum VEGF,serum IGF-1 and urine BLCA-4 levels between the two groups before and 1 week after operation (P>0.05).The difference values of CRP,IL-6,TNF-α levels before and after 1 week in the observation group were significantly lower than those in the control group (P<0.01).The difference values of CD3+CD4+,CD3+CD8+and CD4+/CD8+levels before and after 1 week in the observa-tion group were significantly higher than those in the control group (P<0.01).The total incidence of postoperative adverse reactions in the observation group was significantly lower than that in the control group (P<0.01).The one-year and two-year tumor-free survival rates and overall survival rate of patients in the observation group were significantly higher than those in the control group (P<0.05).Conclusion TUR combined with bladder perfusion chemotherapy effectively could remove malignant tumor cells of the bladder,correct the immune imbalance with micro-trauma and good outcomes in el-derly bladder cancer patients.