吡柔比星膀胱保留灌注预防浅表膀胱癌术后复发临床探究.docVIP

吡柔比星膀胱保留灌注预防浅表膀胱癌术后复发临床探究 　 作者：杨庆 吴海啸 余谦 季敬伟 吴汉 朱再生 【摘要】 目的 探讨吡柔比星(THP)膀胱内灌注预防浅表性膀胱癌术后复发的有效性及安全性。方法 符合入选标准的98位患者随机分成三组于手术后2周内开始行吡柔比星膀胱灌注, 三组的保留灌注时间分别为30min，1、2h。20mg/次, 每周1次共8次； 以后每个月1次共1年, 定期膀胱镜检查进行随访。 结果 98例浅表性膀胱移行细胞癌患者, 术后平均随访时间(11.8±6.83)个月。三组无肿瘤复发率分别为82.36%、80.00%、82.76%，复发率为17.64%、20.00%、17.24%,三组之间差异无显著性；三组的尿路刺激症状发生率分别为35.29%、51.42%、58.62%；全身症状发生率为5.88%、11.43%、24.14%。其中在2h组有4例因为尿路刺激症状及全身症状严重，不能耐受,暂停灌注,其余患者均完成治疗。 结论 THP膀胱内保留灌注30min预防膀胱癌术后复发的疗效满意,患者耐受性好,副作用少。 【关键词】 吡柔比星 膀胱肿瘤 膀胱灌注 　　【Abstract】 Objective To investigate the efficacy and safety of intravesical instillation of pirarubicin(THP) for preventing postoperative recurrence of superficial bladder cancer. Methods 98 Patients with superficial transitional cell bladder cancer who met inclusion criteria were enrolled in this study. 98 patients were divided into three groups : 30min group、1h group and 2h group.THP (20 mg/50 ml of normal saline) was instilled intravesically within two weeks after operation once a week for eight weeks, followed by once a month till one year. Regular cystoscopy was performed for the follow- up. Results All the patients were followed up for an average time of 11.8±6.83 months. Tumor recurrence rate were 17.64%、20.00%、17.24%，there was no significant difference among them .LUTS rate were 35.29%、51.42%、58.62%；general symptom rate were 5.88%、11.43%、24.14%.4 cases in 2h group withdrew the treatment for not being able to tolerate LUTS and general symptom. Conclusion 30min Intravesical administration of THP for 30 min after operation was effective and well- tolerated for preventing tumor recurrence. 　　【Key words】 Pirarubicin Bladder Cancer Intravesical Instillation 　　膀胱癌是一种常见的泌尿系肿瘤，70%～80％为浅表性膀胱癌［１］，大多数膀胱癌可经尿道电切或手术切除，但50％～70％的浅表性膀胱癌术后易复发，其中30％～40％的复发患者伴有恶性程度增加或浸润能力增强。而膀胱内灌注治疗是目前预防浅表性膀胱癌术后复发的最常用的一种治疗手段, 且灌注采用的药物种类繁多［２］。THP( pirarubicin, THP) 是新一代半合成蒽环类抗肿瘤药物, 实验研究结果表明THP在肿瘤组织内弥散速度快, 抗癌活性强, 可有效、迅速杀伤肿瘤细胞, 一些临床观察也证实THP对预防膀胱癌术后复发有着良好的疗效［３，4］。为进一步评价THP膀胱内灌注预防浅表性膀胱癌复发的有效性及安全性, 本院自2002年8月至2005年12月