摘要
目的:分析经尿道等离子膀胱肿瘤切除术(PKRBt)中经膀胱黏膜下多点注射吉西他滨(GEM)治疗对非前壁非肌层浸润性膀胱癌(NMIBC)的效果及安全性。方法:48例NMIBC患者均行PKRBt术治疗,采用随机数字表法将受试者分为A组和B组,各24例。A组术中经膀胱黏膜下多点注射GEM,B组术后即刻灌注GEM,比较两组术后毒副作用,随访肿瘤复发情况及生活质量。结果:A组1、1.5、2年无肿瘤复发生存率分别为92%、83%、79%,B组分别为88%、58%、50%(log-rank testχ^2=4.216,P=0.040<0.05),A组1、1.5、2年无FISH复发生存率分别为79%、67%、67%,B组分别为58%、38%、38%(log-rank testχ^2=4.110,P=0.043<0.05);两组间平均膀胱刺激症状得分不存在显著性差异(P>0.05),均在饮水或对症治疗后缓解;两组毒性反应发生率不存在显著性差异(均P>0.05),多肾功能损伤、胃肠道反应者,给予对症处理后症状均得到缓解,B组发现1例骨髓抑制;随访1年,A组躯体、心理、社会、物质生活四个维度得分均较B组高(均P<0.05)。结论:对NMIBC患者PKRBt术中经膀胱黏膜下多点注射GEM,疗效好,降低了复发率,耐受性好,安全性高,提高了患者术后的生活质量。
Objective To analyze the efficacy and safety of multi-point injection of gemcitabine by bladder submucosa in PKRBt for treating superficial bladder cancer.Methods Selected 48 cases of patients with superficial bladder cancer,who were treated by PKRBt,and all were confirmed as NMIBC by pathology after operation.The selected patients were randomly divided into group A and group B,with 24 cases in each group,Group A was treated with multipoint GEM injection during PKRBt operation,and group B was treated with immediate GEM infusion after PKRBt operation.Toxicity and side effects were compared between the two groups,and tumor recurrence and quality of life were compared during follow-up.Results The survival rates of 1,1.5 and 2 years without tumor recurrence were 91.7%,83.3%,79.2%in group A,while that of group B was 87.5%,58.3%and 50.0%(log-rank testχ^2=4.216,P=0.040<0.05),in addition,the recurrence survival rate of 1,1.5 and 2 years without FISH was 79.2%,66.7%and 66.7%in group A,while that of group B was 58.3%,37.5%and 37.5%(log-rank testχ^2=4.110,P=0.043<0.05);There was no significant difference(P>0.05)in the mean score of bladder irritation between the two groups,and all the patients were relieved after drinking water or symptomatic treatment;There were no significant differences in the incidence of toxic reactions between the two groups(all P>0.05),and the symptoms of multiple renal function injuries and gastrointestinal reactions were relieved after symptomatic treatment,and one of the patients with bone marrow suppression in group B was treated with granulocyte stimulating factor(g-csf),and the blood picture returned to normal;During the 1-year follow-up after surgery,the scores of the four dimensions of body,mind,society and material life of the patients in group A were higher than those in group B,and the differences were statistically significant(all P<0.05).Conclusion GEM injection through the submucosa of the bladder during PKRBt operation of NMIBC has good curative effect,good tolerance and high safety,reduce recurrence rate,and improved the postoperative quality of life of patients,which is worthy of clinical application.
作者
刘杨
夏厚萍
LIU Yang;XIA Hou-ping(Department of Urology,Tongzhou Chinese Medicine Hospital,Nantong226300,China)
出处
《中国中西医结合外科杂志》
CAS
2019年第5期700-704,共5页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
基金
南通市科技计划项目(HS149113)
关键词
PKRBt
吉西他滨
非前壁非肌层浸润性膀胱癌
多点注射
灌注化疗
PKRBt technique
gemcitabine
non muscle invasive bladder cancer
mult-ipoint injection
perfusion chemotherapy
