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目的探讨运用术后即刻及短程膀胱灌注方案预防非浸润性膀胱癌术后复发的疗效。方法对丹阳市人民医院及复旦大学附属华山医院泌尿外科自2012年至2015年收治的39例(I组)病理证实为非浸润性膀胱癌行经尿道膀胱肿瘤电切术(transurethral resection of bladder tumor,TURBt)的患者,术后用蒸馏水膀胱内冲洗后,即刻将40mg吡柔比星溶于40ml蒸馏水进行灌注,维持2小时后排出,术后7天开始规律每周1次共灌注8周,每月1次维持灌注8个月后结束。2012年之前的非浸润性膀胱癌患者45例(Ⅱ组),术后7天始同剂量吡柔比星规律常规膀胱灌注,每周1次共灌注8周,每月1次维持灌注12个月。比较Ⅰ、Ⅱ组患者膀胱肿瘤复发率、不良反应。结果二组进行常规膀胱镜复查随访,随访8~56个月,平均35.9个月,Ⅰ组4例膀胱肿瘤复发,Ⅱ组13例复发,差异有统计学意义;不良反应包括肉眼血尿及尿路刺激征等,两组相比较差异具有统计学意义。结论非浸润性膀胱癌TURBt术后运用优化的膀胱灌注方案(即刻+短程使用吡柔比星)灌注化疗,可以显著降低膀胱肿瘤复发率,减轻不良反应,在中低危非肌层浸润性膀胱癌患者中优点尤其明显,可作为推荐方案使用。
Objective To explore the use of immediate and short-term intravesical instillation regimen to prevent the recurrence of non-invasive bladder cancer. Methods Thirty-nine cases (group I) of pathologically confirmed non-invasive bladder cancer underwent transurethral resection of bladder tumor TURBt) patients, after intravesical irrigation with distilled water, immediately 40mg pirarubicin dissolved in 40ml distilled water for 2 hours after the discharge, 7 days after the start of the rule once a week total perfusion for 8 weeks, each Month 1 to maintain perfusion 8 months after the end. Forty-five patients with non-invasive bladder cancer prior to 2012 (group Ⅱ) received routine intravesical instillation of pirarubicin at regular doses 7 days after operation for a total of 8 weeks per week and 12 times a month month. The recurrence rate and adverse reactions of bladder tumor in group Ⅰ and group Ⅱ were compared. Results The two groups were followed up for routine cystoscopy. The follow-up ranged from 8 to 56 months (average 35.9 months). In group Ⅰ, 4 cases of recurrent bladder tumor and 13 cases of group Ⅱ relapsed with statistically significant differences. The adverse reactions included gross hematuria and urinary tract Irritation sign, the difference between the two groups was statistically significant. Conclusion TURBt non-invasive bladder surgery using optimized bladder irrigation (immediate + short-term use of pirarubicin) infusion chemotherapy can significantly reduce the recurrence rate of bladder cancer and reduce adverse reactions in the low-risk non-muscle invasive bladder The advantages of cancer patients in particular are obvious, can be used as a recommended program.