三种药物行膀胱灌注预防浅表性膀胱肿瘤术后复发效果的临床观察分析

发布时间：2018-03-09 13:01

本文选题：膀胱肿瘤　切入点：吡柔比星（THP）　出处：《青海大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：通过对吡柔比星(pirarubicin,THP)、羟基喜树碱(hydroxycamptothecin,HCPT)丝裂霉素C(mitomycin C,MMC)预防浅表性膀胱癌(SBC)术后复发效果的临床观察分析，旨在更好地探究其临床意义。方法：选取初发膀胱癌患者共141例，其中THP组51例，HCTP组47例，MMC组43例。以上三组分别于TURBT或膀胱部分切除术后的24小时内或即刻行THP、HCPT和MMC的灌注治疗。膀胱灌注可通过留置的导尿管进行。一周以后再次对以上三组患者行膀胱内药物灌注。灌注前作如下准备：1.嘱患者排空尿液；2.常规消毒；3.予以留置导尿。准备完善后行药物灌注，THP在膀胱内保留30分钟，HCPT和MMC在膀胱内保留2小时。在此期间THP组每10分钟嘱灌注后的患者改变体位（仰、两侧、俯）一次，HCPT组、MMC组每30分钟嘱灌注后的患者改变一次体位。药物灌注方案：先嘱患者每周一次行药物灌注，连续8周，以后每月1次，连续10个月。总化疗时间为52周。在一年内嘱灌注后所有患者每3个月行一次检查，包括血液分析检查、尿液分析检查、肝肾功能检查、膀胱镜检查。1年之后每半年复查一次。在每次膀胱灌注后，都认真观察并记录药物引起的副反应情况，如：血尿、膀胱刺激症状等。通过病理检查来确定复查过程中发现的可疑病变是否为术后复发的膀胱癌组织。结果：对术后行膀胱灌注的所有患者随访24个月的结果如下：三组患者术后6个月内总复发率为7.80%，其中THP组复发率为5.88%，HCTP组复发率为4.26%、MMC组复发率为13.96%，差异无统计学意义（P＞0.05）；：三组患者术后12个月内总复发率为14.1%，其中THP组为9.80%、HCTP组为8.51%、MMC组为25.58%，，差异有统计学意义（P＜0.05）；以上三组患者术后24个月内的肿瘤总复发率为18.44%。其中THP组复发率为13.73%、HCTP组复发率为10.64%、MMC组复发率为32.56%，差异有统计学意义（P＜0.05）。三组患者注期间不良发应总发生率为25.85%。在灌注期间膀胱刺激症状的发生率为THP组为17.37%，HCTP组为12.00%，MMC组35.56%，差异有统计学意义（P0.05）；血尿的发生率THP组为1.92%，HCTP组为4.00%，MMC组8.89%，差异无统计学意义(P＞0.05)。结论：THP、HCPT行膀胱灌注预防SBC复发效果明显优于MMC，且不良反应发生率低，值得临床推广应用。
[Abstract]:Objective: to evaluate the clinical effect of pirarubicinus pirarubicinus (THPX), hydroxycamptothecin (HCPT) mitomycin (MMC) on the recurrence of superficial bladder cancer (SBC) after operation, in order to explore its clinical significance. Methods: 141 patients with primary bladder cancer were selected. Among them, 51 cases in THP group, 47 cases in MMC group, 43 cases in MMC group. The above three groups were perfused with THPHCPT and MMC within 24 hours or immediately after TURBT or partial cystectomy. Bladder perfusion could be done by indwelling catheter after one week. Once again, the above three patients were given intravesical drug perfusion. Before perfusion, the following preparations were made: 1. Ask the patient to empty the urine. 2. Routine disinfecting. 3. Place catheterization. After the preparation is completed, the drug will be infused with THP for 30 minutes to retain HCPT and MMC in the bladder. Stay in bladder for 2 hours. During this period, the patients in the THP group changed their posture after instillation every 10 minutes. The patients in the MMC group changed their posture once every 30 minutes. Ten consecutive months. The total chemotherapy time was 52 weeks. After one year of perfusion, all patients were examined every 3 months, including blood analysis, urine analysis, liver and kidney function examination. Cystoscopy. After one year, every six months recheck. After each bladder perfusion, carefully observe and record the side effects caused by drugs, such as: hematuria, Bladder irritation symptoms and so on. Pathological examination to determine whether the suspicious lesions found during the review are recurrent bladder cancer tissue. Results: the results of 24 months follow-up for all patients undergoing bladder perfusion were as follows: the total recurrence rate of the three groups was 7.80 within 6 months after operation, of which the recurrence rate of the THP group was 5.88 and the recurrence rate of the THP group was 4.26. The recurrence rate of the MMC group was 13.96 and there was no statistical difference. The total recurrence rate of the three groups was 14.1% within 12 months after operation, and that in the THP group was 8.51%, 25.58 (P < 0.05), and 18.44% in the THP group (P < 0.05), and the recurrence rate was 18.44% in the THP group (P < 0.05), and the total recurrence rate was 18.44% in the above three groups (P < 0.05), and the recurrence rate was 18.44% in the THP group (P < 0.05), and the total recurrence rate was 18.44% in the THP group (P < 0.05), and the total recurrence rate was 18.44% in the THP group. The recurrence rate of HCTP group was 10.64 and the recurrence rate of MMC group was 32.56, the difference was statistically significant (P < 0.05). The total incidence of adverse hair response in the three groups was 25.85. The incidence of bladder irritation in THP group was 17.37 and 12.00 in THP group, which was 35.565.The difference was statistically significant. The incidence of hematuria in the THP group was 4.00 and 8.89, respectively. There was no significant difference between the two groups (P > 0.05). Conclusion the effect of bladder instillation of HCPT in the prevention of SBC recurrence is better than that in MMC, and the incidence of adverse reactions is low, so it is worth popularizing and applying in clinic.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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