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目的探讨膀胱内灌注纤维蛋白溶解抑制药物增强卡介苗(BCG)预防膀胱癌术后复发的疗效。方法将208例浅表性膀胱移行细胞癌(BTCC)患者术后随机分成5组,A组44例,定期膀胱内灌注BCG 100~120 mg+氨甲苯酸(PAMBA)0.1 g+生理盐水,B组41例,灌注BCG 50~60mg+PAMBA 0.1 g+生理盐水,C组41例,灌注BCG 100~120 mg+氨基己酸(EACA)2.0 g+生理盐水,D组39例,灌注BCG 50~60 mg+EACA 2.0 g+生理盐水,E组43例,灌注BCG 100~120 mg+生理盐水。每周1次,6次后每月1次。灌注后每3个月作膀胱镜检查,必要时取活检明确肿瘤有无复发。结果随访4~58个月,平均22个月,A~E组BTCC复发率分别为10.3%、8.6%、9.7%、9.7%和29.7%。A、B、C、D各组抗BTCC复发的疗效均明显优于E组(对照组),差异有统计学意义(P<0.05);B、D组预防BTCC术后复发的效果与A、C组比较差异无统计学意义。结论膀胱内灌注纤维蛋白溶解抑制药物PAMBA、EACA可增强BCG预防膀胱癌术后复发的疗效,BCG剂量减半后,疗效不降低。
Objective To investigate the effect of intravesical instillation of fibrinolysis inhibiting drugs (BCG) to prevent postoperative recurrence of bladder cancer. Methods 208 patients with superficial transitional cell carcinoma of the bladder (BTCC) were randomly divided into 5 groups, group A (44 cases), regular intravesical instillation of BCG 100 ~ 120 mg + PAMBA 0.1 g + saline, and group B 41 In the group C, 41 cases were injected with BCG 50 ~ 60mg + PAMBA 0.1 g + saline, 41 cases in the C group, 2.0g + BCG 100 ~ 120 mg + aminocaproic acid (EACA) g + saline, Group E 43 cases, perfusion BCG 100 ~ 120 mg + saline. Once a week, once a month after 6 times. Cystoscopy was performed every 3 months after perfusion, and if necessary, biopsy was used to confirm the tumor recurrence. Results The patients were followed up for 4 to 58 months with an average of 22 months. The recurrence rates of BTCC in groups A to E were 10.3%, 8.6%, 9.7%, 9.7% and 29.7%, respectively. The efficacy of anti-BTCC recurrence in groups A, B, C and D were significantly better than that in group E (control group), the difference was statistically significant (P <0.05) C group had no significant difference. Conclusion Intravesical instillation of fibrinolytic drugs PAMBA and EACA can enhance the curative effect of BCG on the prevention of postoperative recurrence of bladder cancer. After half dose of BCG, the curative effect does not decrease.