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目的:探讨上尿路肿瘤术后预防性膀胱内灌注化疗的价值。方法:选取诊断为单侧上尿路肿瘤、无淋巴结及远处转移、不伴发膀胱肿瘤及无膀胱癌病史并行根治性肾输尿管全切除术的患者82例,对其中41例术后接受膀胱内灌注化疗者(研究组)与41例未接受膀胱内灌注化疗者(对照组)进行1:1配对研究,配对条件为肿瘤的病理分期、单发/多发和所处器官一致,患者的性别相同。研究组术后行羟基喜树碱膀胱内灌注化疗,每次40 mg,每周1次,共6～8次;对照组随诊观察。结果:平均随访46(26～66)个月,研究组及对照组术后膀胱癌的发生率分别为22.0%(9例)及43.9%(18例)(P<0.05),再发膀胱癌的中位时间分别为13(3～59)个月及28(3～57)个月(P<0.05)。结论:对不伴发膀胱癌及无膀胱癌病史的上尿路肿瘤患者,根治术后短疗程的羟基喜树碱膀胱内灌注化疗可有效降低膀胱癌的再发比例,延长肿瘤的再发时间。
Objective: To investigate the value of postoperative prophylactic intravesical instillation chemotherapy for upper urinary tract tumors. Methods: 82 patients diagnosed as unilateral upper urinary tract tumor without lymph node and distant metastasis without bladder cancer and no history of bladder cancer were treated with radical radical nephroureterectomy. Among them, 41 cases were treated with bladder One-to-one paired study of 41 patients with intra-perfused chemotherapy (study group) and 41 patients without intravesical infusion chemotherapy (control group) was performed. The pairing conditions were the pathological staging of the tumor, single / multiple organ involvement and the gender of the patient the same. The study group was treated with hydroxycamptothecin intravesical instillation chemotherapy, 40 mg every time, once a week for 6 to 8 times. The control group was followed up. Results: The average incidence of postoperative bladder cancer in study group and control group was 22.0% (9 cases) and 43.9% (18 cases) respectively (46 cases) (26 to 66 months), with recurrent bladder cancer The median time was 13 (3-59) months and 28 (3-57) months (P <0.05). Conclusion: For patients with upper urinary tract tumor who do not have a history of bladder cancer and no bladder cancer, short course of hydroxycamptothecin after radical operation chemotherapy in bladder can effectively reduce the recurrence rate of bladder cancer and prolong the recurrence time of tumor .