肌层浸润性膀胱癌保留膀胱手术后不同辅助化疗方法的效果比较

目的探讨浸润性膀胱癌行保留膀胱手术后髂内动脉灌注化疗与膀胱灌注化疗的治疗效果比较.方法选择T2-3N0M0期膀胱癌患者56名,手术方式为经尿道膀胱肿瘤电切术（TURBT）和膀胱部分切除术,术后1周开始进行化疗.其中24名术后采用髂内动脉灌注化疗,同一时期的其他32名患者则在术后采用膀胱灌注化疗.化疗期间观察患者的副反应,每3个月复查一次膀胱镜和尿细胞学.结果 56名患者共随访18～60个月,平均32个月.髂内灌注组化疗副反应主要为胃肠道反应,恶心呕吐发生率75.0%,此外有部分骨髓抑制表现,有29.2%白细胞下降.膀胱灌注组主要副反应为膀胱刺激症状,发生率为37.5%.观察期内肿瘤复发率髂内化疗组为25.0%,而膀胱灌注组复发率为56.3%（P〈0.05）.观察期间内,56名患者均未发生死亡.结论浸润性膀胱癌行保留膀胱手术后配合髂内动脉灌注化疗可以降低肿瘤复发率,无明显化疗副作用,对于某些不适宜或不愿意行根治性膀胱切除术的患者是一种理想的选择.

The Comparison of Different Adjuvant Chemotherapy in Postoperative Treatment of Muscle Invasive Bladder Cancer

Objective To evaluate the effects of the different adjuvant chemotherapy in the treatment of muscle invasive bladder cancer after bladder preservation operation.Methods Bladder preservation operation were performed in 56 cases of bladder cancer staging T2-3N0M0.Intra-arterial chemotherapy（Group A） were administrated in 24 patients one week after the operation,the other 32 patients（Group B） conducted bladder instillation chemotherapy.The side effects and the recurrent rate were observed.The urinary cytological examination and cystoscopic examination were conducted every three months. Results All patients were followed up for 18～60 months,and the average follow-up time was 32 months. During the observation period,the side effects in Group A mainly included gastrointestinal tract reactions（75.0%） and bone marrow suppression（29.2%） .Irritation sign of bladder happened in 37.5% of patients in Group B.The recurrent rate in Group A was 25.0%,while the recurrent rate was 56.3% in Group B（P0.05） during the observation period. There was no death cases in all patients during observation period. Conclusion Bladder preservation operation and adjuvant intra-arterial chemotherapy can decrease the recurrent rate in high selective patients with muscle invasive bladder cancer,andhave no obvious side reactions,so it is an ideal choice for patients not suitable for radical cystectomy.