即刻膀胱热灌注化疗预防NMIBC术后复发的临床疗效分析

发布时间：2018-04-17 22:40

本文选题：膀胱癌 + 即刻热灌注化疗　；参考：《郑州大学》2017年硕士论文

【摘要】：背景和目的:膀胱癌(bladder cancer,BC)好发于老年人。男性发病率是女性的3~4倍,发病率在全球范围内排名恶性肿瘤第九位,致死率列全球男性泌尿生殖系统肿瘤第二位。根据膀胱癌组织是否浸润膀胱肌层,分为非肌层浸润性膀胱癌(non muscle invasive bladder cancer,NMIBC)和肌层浸润性膀胱癌(muscle invasive bladder cancer,MIBC),二者的手术方式、预后、术后生活质量有显著的不同。在初诊的膀胱癌患者中,NMIBC占70%-80%,经尿道膀胱肿瘤切除术(trasnurethral resection of bladder tumor,TURBT)是其首选的治疗手段,然而TURBT术后高复发率使患者需要接受定期的膀胱镜检查和长期的膀胱灌注化疗,生活质量大大下降同时也加重了患者的经济负担,故如何减少NMIBC术后肿瘤复发是当今膀胱癌治疗中迫切解决的难题。膀胱癌术后复发原因复杂,TURBT术后癌细胞残留与膀胱腔内种植是NMIBC复发的重要原因之一,故清除TURBT术后膀胱内残留肿瘤细胞,减少术后腔内种植对预防NMIBC术后复发具有重要意义。研究表明TURBT术后膀胱灌注化疗的早晚对术后肿瘤复发具有不同的效果,即膀胱灌注化疗越早预防膀胱癌复发的效果越好,主要是因为早期的膀胱灌注化疗能够更加有效的杀灭术后残留的肿瘤细胞。随着膀胱癌复发机制研究的不断深入,TURBT术后进行的灌注时机逐渐被泌尿外科医师所重视,即刻膀胱灌注化疗因其能够更加有效地杀灭术后残留的肿瘤细胞受到国内外专家的推崇。根据膀胱灌注化疗药物温度的不同,将其分为常温膀胱灌注化疗和与热疗结合的膀胱热灌注化疗(hyperthermic intravescial chemotherapy,HIVEC),与常温灌注化疗相比,HIVEC能够显著降低NMIBC术后复发率,延长患者的生存时间,但是考虑到TURBT术后出血、穿孔等并发症的发生,HIVEC的灌注时机一般为术后3至7天,行TURBT术后即刻HIVEC的相关报道较少,本研究回顾性分析44例应用BR-TRG-Ⅰ型体腔热灌注治疗系统施行的TURBT术后吉西他滨即刻膀胱热灌注化疗患者的临床资料,并与同期吉西他滨常温即刻灌注化疗的患者进行对比,研究TURBT术后即刻膀胱灌注化疗的安全性以及对术后膀胱癌复发率的影响。方法:本研究为回顾性研究,以2015年8月至2016年2月郑州大学人民医院泌尿外科收治84例非肌层浸润性膀胱癌患者为研究对象,根据术后即刻膀胱灌注方式的不同分为即刻热灌注组和对照组,其中即刻热灌注组44例,在行TURBT切除肿瘤后,应用BR-TRG-Ⅰ型体腔灌注治疗系统行吉西他滨即刻膀胱热灌注化疗;对照组40例,行经尿道膀胱肿瘤电切术后常温下即刻吉西他滨膀胱灌注化疗;之后两组均按疗程持续膀胱灌注1年。对比分析两组不同温度的即刻膀胱灌注化疗的不良反应、膀胱癌术后6个月以及12个月的复发率。结果:即刻热灌注组与对照组的年龄、性别、BMI、伴发疾病、膀胱肿瘤相关指标比较差异无统计学意义(P0.05);即刻热灌注组的肿瘤切除时间、术后膀胱冲洗时间、术后留置尿管时间、住院总花费与对照组相近,差异无统计学意义(P0.05);不良反应方面,即刻热灌注组不良反应主要为血尿(25.0%)、尿频(20.5%)、尿痛(18.2%)、发热(5.9%)、胃肠道反应(11.8%);对照组发生率分别为37.5%、27.5%、22.5%、7.5%、10.0%,两组比较差异无统计学意义(P0.05);术后6个月的复发率:即刻热灌注组为11.4%;对照组22.5%,差异无统计学意义(P0.05),术后12个月即刻热灌注组复发率为18.1%,对照组为37.5%,两组比较差异有统计学意义(P0.05),即刻热灌注组的无复发生存时间为(14.30±0.58)个月,对照组(13.70±0.92)个月,即刻热灌注组无复发生存时间长于对照组,差异有统计学意义(P0.05)。结论:1、应用BR-TRG-Ⅰ型体腔热灌注治疗系统行TURBT术后吉西他滨即刻膀胱热灌注化疗是可行的,不良反应与即刻常温灌注化疗相似,应用本研究介绍的热灌注化疗实施方法,可保留电切镜在膀胱内,实现热灌注化疗过程的可视化,确保即刻膀胱热灌注化疗的顺利进行,安全性更好;2、术后即刻吉西他滨热灌注化疗与常温即刻膀胱灌注化疗相比,可以降低NMIBC术后的短期复发率,延长近期的无复发生存时间;但是其预防复发的远期疗效还有待进一步的随机对照试验和大宗病例分析进一步证实。
[Abstract]:Background and objective: bladder cancer (bladder cancer, BC) occurs in the elderly. The male incidence rate is 3~4 times higher than women, the incidence of malignant tumors in the world ninth, the death rate among global male urogenital tumor. According to the second bladder cancer tissue infiltration of bladder muscle layer, divided into non muscle invasive bladder cancer (non muscle invasive bladder cancer, NMIBC) and muscle invasive bladder cancer (muscle invasive bladder cancer, MIBC), the prognosis of surgery, two, postoperative quality of life is significantly different in newly diagnosed bladder cancer patients, NMIBC 70%-80%, transurethral resection of bladder resection of the tumor (trasnurethral resection of bladder tumor, TURBT) is the preferred means of treatment, but the TURBT high recurrence rate after operation. Patients need regular cystoscopy and long-term intravesical chemotherapy, quality of life is greatly reduced with the When increasing the economic burden of the patients, so how to reduce tumor recurrence after NMIBC is solved in the treatment of bladder cancer. The causes of postoperative recurrence of bladder cancer after TURBT complex, residual cancer cells and bladder planting is one of the important reasons for the recurrence of NMIBC, so the removal of residual tumor cells after TURBT of bladder in the reduction of postoperative intraluminal implantation has important significance in preventing the recurrence of NMIBC after operation. The results show that the TURBT postoperative bladder perfusion chemotherapy on tumor recurrence after surgery sooner or later has different effect, namely intravesical chemotherapy sooner the better effect of preventing the recurrence of bladder cancer, mainly because of residual bladder perfusion chemotherapy can be more early the effective killing of tumor cells. With the operation mechanism of bladder cancer recurrence continues, time after TURBT perfusion gradually by the Department of Urology physicians attention, immediate intravesical perfusion Because of the chemotherapy can effectively kill residual tumor cells after surgery is praised by domestic and foreign experts. According to the intravesical chemotherapy temperature, which can be divided into normal bladder perfusion chemotherapy and hyperthermia therapy combined with bladder perfusion chemotherapy (hyperthermic intravescial, chemotherapy, HIVEC), compared with normal perfusion chemotherapy, HIVEC significantly reduce the recurrence rate of NMIBC after operation, prolong the survival time of patients, but considering the TURBT postoperative bleeding, perforation and other complications, time is generally HIVEC reperfusion after 3 to 7 days after TURBT reported less immediate HIVEC, this study retrospectively analyzed 44 patients performed using BR-TRG- type cavity thermal perfusion treatment system TURBT surgery clinical data of patients with gemcitabine immediately intravesical perfusion chemotherapy, and compared with normal perfusion chemotherapy gemcitabine immediately in patients. The TURBT after the operation safety of immediate intravesical chemotherapy and the recurrence rate of bladder cancer after operation. Methods: This was a retrospective study from August 2015 to February 2016, the people's Hospital of Zhengzhou University, Department of Urology treated 84 cases of non muscle invasive bladder cancer patients as the research object, according to the different postoperative instillation method for immediate perfusion group and control group, the immediate perfusion group of 44 patients undergoing TURBT after tumor resection, type cavity perfusion treatment system for gemcitabine immediately intravesical perfusion chemotherapy by BR-TRG-; 40 cases in the control group underwent transurethral resection of bladder tumor under the normal temperature after immediate intravesical gemcitabine chemotherapy; group two according to the course of treatment lasted 1 years. Intravesical comparative analysis of adverse reactions of the two groups of different temperature immediate intravesical chemotherapy after resection of bladder cancer, 6 months and 12 months. The recurrence rate : immediate perfusion group and control group in age, gender, BMI, concomitant disease, there was no significant difference between bladder cancer index (P0.05); instant heat perfusion group tumor resection time, bladder irrigation time, indwelling catheter time, total hospitalization costs between the two groups, no significant difference the significance (P0.05); adverse reactions, mainly instant heat perfusion group adverse reactions were hematuria (25%), frequent urination, dysuria (20.5%) (18.2%), fever (5.9%), gastrointestinal reactions (11.8%); the control group was respectively 37.5%, 27.5%, 22.5%, 7.5%, 10%, the difference between the two groups no statistical significance (P0.05); 6 months postoperative recurrence rate: immediate perfusion group was 11.4%; the control group 22.5%, the difference was not statistically significant (P0.05), 12 months after surgery, immediate perfusion group the recurrence rate was 18.1%, the control group was 37.5%, there was significant difference between two groups (P0.05) immediately, perfusion group The recurrence free survival time was (14.30 + 0.58) months, the control group (13.70 + 0.92) months, instant heat perfusion group the recurrence free survival time longer than the control group, the difference was statistically significant (P0.05). Conclusion: 1. The application of BR-TRG- type hyperthermic perfusion system after TURBT immediate intravesical gemcitabine perfusion chemotherapy is feasible and adverse reaction of chemotherapy and immediate perfusion at room temperature is similar to that of the application chemohyperthermia in this paper, can be retained in the bladder Resectoscopy, visualization of perfusion process, ensure immediate bladder perfusion chemotherapy heat smoothly, better safety; 2, immediately after the operation gemcitabine perfusion chemotherapy and normal instillation compared to chemotherapy can reduce the NMIBC postoperative short-term recurrence rate, prolong recurrence free survival in prevention of recurrence; but its long-term efficacy remains to be further randomized controlled Test and large case analysis were further confirmed.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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