丝裂霉素与卡介苗联合灌注预防表浅膀胱癌术后复发的疗效观察

目的评价丝裂霉素（MMC）和卡介苗（BCG）联合灌注预防表浅膀胱癌术后复发的疗效。方法110例患者经病理检查确诊为表浅移行细胞癌,接受经尿道切除手术（TUR）。术后分为2组：A组为联合诱导组（59例）,术后6h内及术后1周、2周分别行膀胱腔内灌注MMC,术后3周开始BCG诱导加维持膀胱腔内灌注治疗（BCG“6＋3”疗法）。B组为单纯BCG组（51例）,术后3周开始接受BCG“6＋3”疗法。定期行膀胱镜和尿脱落细胞学检查,观察2组患者的肿瘤复发和毒副反应情况。结果经过12—70个月,中位35个月随访,A组9例患者肿瘤复发（9／59,复发率15．3％）,B组17例患者肿瘤复发（17／51,复发率33．3％）,2组复发率有显著性差异（P〈0．05）;2组肿瘤进展发生率均低,差异不显著;2组膀胱炎的发生率分别为39．0％、35．3％,差异无显著性意义。结论经尿道膀胱肿瘤切除术后早期MMC膀胱灌注加BCG定期灌注预防表浅膀胱癌术后复发疗效较好,且比较经济,未增加毒副反府发生率．临床使用安全可靠。

Intravesical instillation of mitomycin C and bacillus Calmette-Guerin for the prevention of post-operative recurrence of superficial transitional cell carcinoma of the bladder

Objective To compare the prophylactic efficacy of intravesical instillation of mitomycin C(MMC) and bacillus Calmette-Guerin(BCG) with BCG alone on recurrence of stages Ta and Tl bladder carcinoma.Methods A total of 110 patients with superficial bladder cancers after complete transurethral resection(TUR) were randomized to receive intravesical MMC and BCG(group A,59 cases)or BCG alone(group B,51 cases).To prevent recurrence of superficial bladder cancer,Group A cases were managed with intravesical instillation of 20 mg MMC immediately after TUR,and at first week,second week,followed with BCG"6+3"regimen.Group B cases were treated with BCG"6+3"regimen alone.Cystology and urine cytolegy were performed every 3 months for one year,every 6 months for the second and third year,and then yearly.The side effects during the course were observed.Results Final analysis was made at median follow-up of 35 months(12~70 months)for recurrence,progression and side-effects,respcctively.The recurrence rates of group A and group B were 15.3%(9/59) and 33.3%(17/51),respectively.The recurrence rates differ significantly between two groups.For side effects and progression,the two groups show low rates and no significant differences.Conclusions Adjuvant intravesical MMC plus BCG could show reducing recurrence of superficial bladder cancer,compared with controls during follow-up.Furthermore,this therapy has few significant side effects.