不同剂量卡介苗膀胱灌注预防浅表性膀胱癌复发的效果.docVIP

不同剂量卡介苗膀胱灌注预防浅表性膀胱癌复发的效果 　　作者：张怀强,周春文,马天加,王绍勇,葛南　　作者单位：山东大学第二医院泌尿外科， 济南 250033 　　【摘要】目的 小剂量(40?mg)卡介苗(BCG)膀胱灌注与常规剂量(120?mg)膀胱灌注比较，评价其预防浅表性膀胱癌术后复发的疗效及其对并发症发生率的影响。方法 随机将150例浅表性膀胱癌患者术后均分为三组。1组：常规剂量灌注组(BCG 120?mg);2组：半剂量灌注组(BCG 60?mg);3组：小剂量灌注组(BCG 40?mg)。术后1周开始BCG+生理盐水50?mL膀胱内灌注，每周1次，6次后每月1次，术后每3个月行尿细胞学检查、膀胱镜活检等随访监测，比较各组间膀胱癌的复发率及灌注后并发症的发生率。结果 随访12～30个月，平均20个月，1、2、3组膀胱癌的术后复发率分别为15.2%、14.3%、18.0%，2、3组分别与1组比较，差异无统计学意义(Χ22vs1=0.02，P0.05;Χ23vs1=0.13， P0.05)。1、2、3组膀胱灌注卡介苗后的并发症发生率分别为22%、10%、6%，3组的发生率显著低于1组(Χ2=4.07，P0.05)。结论 小剂量卡介苗膀胱灌注预防浅表性膀胱癌术后复发的效果等同于常规剂量，而灌注后并发症发生率显著减少，有较高临床应用价值。 　　【关键词】 卡介苗;膀胱肿瘤;癌;预防 　　ZHANG Huaiqiang, ZHOU Chunwen, MA Tianjia, WANG Shaoyong, GE Nan 　　(Department of Urology, Second Hospital of Shandong University, Jinan 250033, China) 　　To explore the effect of low dose bacillus CalmetteGuerin(BCG) intravesical instillation in preventing superficial bladder transitional cell carcinoma(BTCC) recurrence and complications. Methods 150 patients with superficial BTCC who underwent transurethral resection of a bladder tumor or partial cystectomy were randomly divided into 3 groups: group 1 (50 cases) received a standard dose (120?mg) BCG treatment, group 2 (50 cases) received half a standard dose (60?mg) BCG, and group 3 received a low dose (40?mg) BCG. Each patient was given a regular instillation schedule: different doses of BCG plus 50?mL NS were instilled into bladders once a week, and after 6 weeks, the treatment was performed once a month. Urine cytology and cystoscopy were used to monitor the recurrence at 3month intervals and the side effects of the BCG treatment were surveyed. Results At a median followup of 20 months (ranging from 12 to 30), the rates of tumor recurrence in groups 1, 2 and 3 were 15.2%, 14.3% and 18.0%. There was a no significant difference between group 1 and 2 (Χ22vs1=0.02, P0.05) or between group 1 and group 3 (Χ23vs1=0.13， P0.05). The rates of complications in groups 1, 2 and 3 were 22%, 10% and 6%. Ther