吡柔比星膀胱内灌注对膀胱原位癌早期诊断的临床观察.docVIP

吡柔比星膀胱内灌注对膀胱原位癌早期诊断的临床观察 　　摘要：目的 ?^察THP（吡柔比星）给予膀胱内灌注后行普通膀胱镜活检下膀胱原位癌的阳性检出率，避免漏诊。方法 患者膀胱完全排空后行50 mg THP膀胱灌注，保留15 min后排出，置入膀胱镜检查，观察肿瘤组织及周围膀胱粘膜染色情况，并随机留取活检，肿瘤蒂旁2 cm处及膀胱其他部位非染色区域组织作为随机对照，分析比较染色结果。结果 明显病变组织及染色区共留取黏膜组织 346块，全部为染色橘黄色，其中病理回报证实膀胱原位癌（CIS）组织288块，非典型增生组织12块，非肌层浸润性膀胱移行上皮癌（Ta、Tis、T1）组织20块，慢性膀胱炎组织26块；非染色区留取黏膜组织140块，其中病理回报证实CIS组织8块，非典型增生组织4块，慢性膀胱炎组织20块，正常膀胱组织108块。（308/346）比（8/140），差异有统计学意义P0.05，膀胱癌吸收THP的敏感度及特异性分别为97.5%、77.7%，均顺利完成检查。结论 THP可提高了对膀胱内微小病变和扁平病变尤其是原位癌的检出率，经济、安全、适应性广。 　　关键词：膀胱原位癌；吡柔比星；膀胱灌注；早期诊断 　　Clinical Observations of Early Diagnosis of Bladder Carcinoma in Situ Through Intravesical Instillation with THP 　　TANG Lei，ZHAO Ya-wei，MA Liu-jiang，LI Zhi-kun，WANG Jian，MA Wang 　　（Department of Urology Surgery，Xinjiang Production and Construction Corps Hospital，Urumqi 830002，Xinjiang，China） 　　Abstract：Objective The study was carried out to observe the positive rate of bladder carcinoma in situ detected under conventional cystoscope biopsy following intravesical instillation with THP， so as to guard against misdiagnosis. Methods After urinary bladder of patient was completely emptied， intravesical instillation with 50mg of THP was performed. Cystoscope was placed 15 minutes thereafter， to observe the staining conditions of tumor tissues and peripheral bladder mucosae. Biopsy tissues were randomly reserved to compare with tissues at 2cms beside tumor pedicle and other non-staining bladder tissues. The staining results were compared and analyzed. Results Totally 346 pieces of mucosae， all in the staining color croci， were taken from the obviously pathological tissues and the stained areas. Pathological reports verified that 288 pieces were stricken with bladder carcinoma in situ （CIS）， 12 with atypical hyperplasia， 20 with non-muscular-invasion transitional cell caricinoma of bladder （Ta， Tis， T1）and 26 with chronic cystitis. Altogether 140 pieces of mucosae were taken from the non-staining areas. Pathological reports verified 8 pieces were stricken with C