TURBT术后常用药物膀胱灌注治疗预防肿瘤复发的临床疗效观察研究

发布时间：2018-03-01 14:02

本文关键词： 非肌层浸润性膀胱癌膀胱灌注化疗吡柔比星羟基喜树碱表柔比星　出处：《延安大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的在泌尿系统中膀胱癌是最常见的恶性肿瘤。根据癌细胞侵犯膀胱壁的程度，，非肌层浸润性膀胱癌（NMIBC）及肌层浸润性膀胱癌（MIBC）是膀胱癌中两个主要的类型。非肌层浸润性膀胱癌在膀胱癌中所占的比例大约是75%～85%，TURBT术是其主要的治疗手段，但是膀胱癌预后的重大影响因素是术后肿瘤复发。预防膀胱癌术后复发最重要的方法是在术后给予膀胱灌注化疗，但膀胱灌注化疗目前没有统一的治疗方案。本回顾性临床研究，选择陕西省人民医院泌尿外科2008年1月至2012年3月四年期间的257例非肌层浸润性膀胱癌患者，均使用TURBT术治疗，术后定期给予吡柔比星、表柔比星、羟基喜树碱的膀胱腔内灌注化疗，将其临床疗效及毒副作用进行比较分析研究，探讨经尿道膀胱肿瘤切除术（TURBT）后给予膀胱内灌注化疗在防止膀胱癌术后复发方面的临床效果，为膀胱癌患者的临床治疗提供一定的依据。方法把257例非肌层浸润性膀胱癌患者，给予TURBT手术治疗，按照随机原则将其分成两大部分，术后给予膀胱灌注化疗并定期复查及随访，严密监测患者的并发症及复发状况，以术后两年为随访期限。一部分是早期膀胱灌注（138例）：Ⅰ组、术后24h内给予吡柔比星膀胱灌注（50例），Ⅱ组、术后24h内给予表柔比星膀胱灌注（41例），Ⅲ组、术后24h内给予羟基喜树碱膀胱灌注（47例）。另一部分是常规膀胱灌注(119例)：A组、术后1周给予吡柔比星膀胱灌注（43例），B组、术后1周给予表柔比星膀胱灌注（39例），C组、术后1周给予羟基喜树碱膀胱灌注（37例）。结果（1）早期膀胱灌注 ①Ⅰ组、Ⅱ组、Ⅲ组的两年复发率分别为：8.00%、24.39%、25.53%；Ⅰ组和Ⅱ组、Ⅰ组和Ⅲ组的对比均有统计学意义（P0.05），Ⅱ组和Ⅲ组对比无统计学意义（P0.05）。 ②三组的血常规、尿常规、肝功能、肾功能均无显著异常，均未发生膀胱穿孔、创面不愈合及全身严重的不良反应。 ③Ⅰ组、Ⅱ组、Ⅲ组的短期膀胱刺激症状发生率分别为：24.00%、21.95%、23.40%，三组比较无统计学意义（P0.05）。 ④Ⅰ组、Ⅱ组、Ⅲ组的血尿发生率分别为：12.00%、12.20%、12.77%，三组比较无统计学意义（P0.05）。（2）常规膀胱灌注 ①A组、B组、C组的两年复发率分别为：23.26%、46.15%、29.73%；B组与C组、A组与C组对比都无统计学意义（P0.05），A组与B组对比有统计学意义（P0.05）。 ②三组的血常规、尿常规、肝功能、肾功能均无明显异常，均无膀胱穿孔、创面不愈合及全身严重的不良反应。 ③A组、B组、C组的短期膀胱刺激症状发生率分别是：18.60%、17.95%、18.92%，三组比较无统计学意义（P0.05）。 ④A组、B组、C组的血尿发生率分别是：9.30%、10.26%、8.11%，三组比较无统计学意义（P0.05）。（3）早期、常规膀胱灌注 ①吡柔比星的早期与常规膀胱灌注、表柔比星的早期与常规膀胱灌注的两年复发率对比都有统计学意义（P0.05），羟基喜树碱的早期与常规膀胱灌注的两年复发率对比无统计学意义（P0.05）。 ②吡柔比星的早期与常规膀胱灌注、表柔比星早期与常规膀胱灌注、羟基喜树碱的早期与常规膀胱灌注的膀胱刺激症状对比都无统计学意义（P0.05）。 ③吡柔比星的早期与常规膀胱灌注、表柔比星早期与常规膀胱灌注、羟基喜树碱的早期与常规膀胱灌注的血尿情况对比都无统计学意义（P0.05）。（4）临床费用吡柔比星的价格是189元/支，单次治疗费用是567元/次；表柔比星的价格是136元/支，单次治疗费用是408元/次；羟基喜树碱的价格是145元/支，单次治疗费用是290元/次。结论（1）吡柔比星早期膀胱灌注化疗的临床疗效显著优于吡柔比星常规膀胱灌注、表柔比星早期膀胱灌注、羟基喜树碱早期膀胱灌注，是一种有效、安全的防止非膀胱癌术后复发的治疗方案，值得进一步推广应用于临床。（2）吡柔比星常规膀胱灌注化疗的临床疗效显著优于表柔比星常规膀胱灌注，羟基喜树碱与表柔比星的临床疗效无显著差异。（3）吡柔比星、表柔比星及羟基喜树碱的毒副作用无显著差异且均较小，一般患者都可耐受。（4）吡柔比星组的治疗费用显著高于表柔比星组及羟基喜树碱组的治疗费用，尤其是羟基喜树碱的临床治疗费用更具有价格方面的优势，有利于避免患者因经济压力大而导致治疗中断。
[Abstract]:The purpose of the urinary system in bladder cancer is the most common malignant tumors. According to the degree of cancer cell invasion to the bladder wall, non muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) are the two main types of bladder cancer. Non muscle invasive bladder cancer for bladder the proportion of cancer is about 75% ~ 85%, TURBT surgery is the main treatment, but significant factors affecting the prognosis of bladder cancer is tumor recurrence after operation. The most important method of preventing bladder cancer recurrence after surgery is given intravesical chemotherapy after operation, but there is no bladder perfusion chemotherapy regimen of unity. In this retrospective study, select the Department of Urology of Shaanxi People's Hospital during the four years from January 2008 to March 2012, 257 patients with non muscle invasive bladder cancer patients, using TURBT treatment, postoperative regular pirarubicin, epirubicin, hydroxycamptothecin Intravesical perfusion chemotherapy, the curative effect and side effect of comparative analysis, to explore the transurethral resection of bladder tumor (TURBT) treated with intravesical chemotherapy in the clinical effect of preventing recurrence of bladder cancer after operation, to provide a basis for clinical treatment of patients with bladder cancer.
Methods 257 cases of non muscle invasive bladder cancer patients were treated with TURBT operation. According to the principle of randomization, they were divided into two parts. Postoperative bladder perfusion chemotherapy and regular follow-up and follow-up were performed. The complications and recurrence of patients were closely monitored.
Part of them were early intravesical instillation (138 cases): group I, intravesical instillation of pirarubicin (50 cases) within 24h after operation, group II, intravesical instillation of epirubicin in 41 cases after 24h, group III, intravesical instillation of Hydroxycamptothecin in 24h (47 cases).
The other group was routine bladder irrigation (119 cases), group:A, 1 weeks after the operation, 43 patients were given intravesical instillation of pirarubicin, and group B was given intravesical instillation of epirubicin 1 weeks after operation (39 cases). Group C was given hydroxycamptothecin intravesical instillation (37 cases) 1 weeks after operation.
Result
(1) early instillation of bladder
The recurrence rates of group I, group II and group III were 8%, 24.39% and 25.53%, respectively. There was a significant difference between group I and group II (P0.05), but there was no significant difference between group II and group III (P0.05).
There were no significant abnormalities in blood routine, urine routine, liver function and renal function in the three groups, and no bladder perforation, nonunion of the wound and severe adverse reaction to the whole body were not occurred.
The incidence of short-term bladder irritation in group I, group II and group III were 24%, 21.95%, 23.40%, respectively, and there was no significant difference in the three groups (P0.05).
(4) the incidence of hematuria in group I, group II and group III were 12%, 12.20%, 12.77%, and there was no statistical significance in group three (P0.05).
(2) routine instillation of bladder
(1) the recurrence rates of group A, group B and group C were 23.26%, 46.15% and 29.73%, respectively. There was no statistical difference between group B and group C (P0.05), and there was a significant difference between A group and B group (P0.05).
The three groups had no obvious abnormalities in blood routine, urine routine, liver function and renal function, no bladder perforation, nonunion of wound and serious adverse reaction to the whole body.
(3) the incidence of short-term bladder irritation in group A, group B and group C were 18.60%, 17.95%, 18.92%, respectively, and there was no significant difference between the three groups (P0.05).
(4) the incidence of hematuria in group A, group B and group C were 9.30%, 10.26%, 8.11%, and there was no statistical significance in group three (P0.05).
(3) early instillation of bladder
(1) the early recurrence rate of pirarubicin compared with routine bladder irrigation and the recurrence rate of epirubicin in the early and routine intravesical instillation was statistically significant (P0.05). There was no statistically significant difference between the early recurrence rate of HCPT and the routine bladder perfusion in two years (P0.05).
There was no statistically significant difference between early and routine intravesical instillation of pirarubicin and epirubicin in comparison with routine bladder irrigation and Hydroxycamptothecin in bladder irritation between early and routine intravesical instillation (P0.05).
There was no statistically significant difference between early and routine intravesical instillation of pirarubicin and epirubicin in comparison with routine intravesical instillation and Hydroxycamptothecin in comparison with hematuria in routine and intravesical instillation. (P0.05).
(4) clinical costs
The price of pirarubicin is 189 yuan / branch, the cost of a single treatment is 567 yuan / times, the price of epirubicin is 136 yuan / branch, the cost of single treatment is 408 yuan / time, the price of hydroxycamptothecin is 145 yuan / branch, the cost of single treatment is 290 yuan / time.
conclusion
(1) the clinical curative effect of pirarubicin star early intravesical chemotherapy was significantly better than that of pirarubicin intravesical epirubicin, early intravesical instillation of hydroxycamptothecin, early bladder perfusion, is an effective and safe treatment to prevent non recurrence after resection of bladder cancer, it is worthy of further promotion in clinical application.
(2) the clinical efficacy of pirarubicin routine intravesical instillation chemotherapy is significantly better than that of routine bladder irrigation with epirubicin. There is no significant difference in clinical efficacy between hydroxycamptothecin and epirubicin.
(3) there was no significant difference in side effects between pirubicin, epirubicin and hydroxycamptothecin, and all patients were tolerable.
(4) the cost of treatment of pirarubicin group was significantly higher than that of epirubicin group and hydroxycamptothecin group, especially the cost of clinical treatment of hydroxycamptothecin has more advantages in price, which is beneficial to avoid the interruption of treatment due to the economic pressure.

【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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