动脉化疗栓塞治疗晚期膀胱癌伴血尿患者的临床疗效评价

发布时间：2018-05-07 04:06

本文选题：化疗栓塞 + 晚期　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:评价动脉化疗栓塞治疗晚期膀胱癌伴血尿患者的临床疗效。方法:回顾分析在2015年3月至2016年12月期间,行膀胱动脉或选择性髂内动脉化疗栓塞治疗的31例晚期膀胱癌伴血尿患者。所有患者均经病理证实为尿路上皮癌。肿瘤TNM分期为T3-T4,其中T3期12例,T4期19例。31例患者中男23例,女8例,平均年龄72.0岁。临床症状:全部患者均有不同程度肉眼血尿;6例尿路阻塞,其中4例因血凝块致排尿困难,均需导尿及持续膀胱冲洗,2例由肿瘤阻塞输尿管口致尿路积水,1例经皮肾穿刺造瘘术;膀胱刺激征5例,表现为排尿时尿道针刺感或烧灼感。介入手术均采用双侧膀胱动脉或选择性髂内动脉化疗栓塞。使用的动脉灌注化疗药物为氟尿嘧啶(500mg~750mg)、吉西他滨(500mg~1000mg)或/和奥沙利铂(50mg~150mg)。使用的栓塞剂为明胶海绵颗粒、明胶海绵条、个别患者结合使用弹簧圈。在患者经首次化疗栓塞4周后,观察近期临床症状改善情况及疾病控制率。结果:动脉化疗栓塞技术成功率100%,31例患者在5日内血尿均得到有效控制,血尿消失者为90.3%(28/31),剩余3例患者术后尿色变淡,病情稳定,未再行进一步治疗,4周后无复发或病情加重病例;6例尿路阻塞患者中,4例因血凝血块致排尿困难者均得到缓解;2例尿路积水患者症状未见消失,但其中1例经治疗膀胱肿瘤体积明显缩小。5例膀胱刺激征患者,术后均得到缓解。根据实体瘤治疗疗效评价标准:部分缓解13例,稳定11例,进展7例,治疗有效率为41.9%(13/31),疾病控制率为77.4%(24/31)。结论:动脉化疗栓塞可有效改善晚期膀胱癌伴血尿患者的临床症状,提高生活质量,并控制肿瘤生长,患者可耐受度强,近期疗效良好。
[Abstract]:Objective: to evaluate the clinical efficacy of arterial chemoembolization in the treatment of advanced bladder cancer with hematuria. Methods: from March 2015 to December 2016, 31 patients with advanced bladder cancer with hematuria were treated with bladder artery or selective internal iliac artery chemoembolization. All patients were confirmed by pathology as urothelial carcinoma. The TNM stage of the tumor was T3-T4, of which 12 cases were T4 stage. Among them, 23 cases were males and 8 cases were females, with an average age of 72.0 years. Clinical symptoms: all patients had different degrees of gross hematuria in 6 cases of obstruction of urinary tract, among which 4 cases had difficulty in urination caused by blood clots. Two cases of ureteral hydronephrosis caused by tumor obstruction of ureter orifice were treated by percutaneous nephrostomy, and 5 cases of bladder irritation were shown as urethral acupuncture or burning sensation during urination. Interventional surgery was performed with bilateral bladder artery or selective internal iliac artery chemoembolization. The chemotherapeutic agents for arterial infusion were fluorouracil (500 mg / g) and gemcitabine (500 mg / 1 000 mg / g) or / and oxaliplatin (50 mg / g) and / or oxaliplatin (50 mg / g) respectively. The embolization agents used are gelfoam granules, gelatin sponge strips, and coils are used in combination with individual patients. The improvement of clinical symptoms and disease control rate were observed 4 weeks after the first chemoembolization. Results: the successful rate of arterial chemoembolization was 100% and 31 cases were effectively controlled within 5 days. The hematuria disappeared in 90.3% of 31 cases. In 6 patients with urinary tract obstruction, 4 patients with dysuria caused by blood clot were relieved and 2 patients with hydronephrosis did not disappear after 4 weeks of further treatment. But in one case, the volume of bladder tumor was significantly reduced in 5 cases of bladder irritation sign, and all cases were relieved after operation. According to the evaluation criteria for the treatment of solid tumors, there were 13 cases of partial remission, 11 cases of stability, 7 cases of progress, the effective rate of treatment was 41.9% and 13 / 31%, and the disease control rate was 77.4% / 31%. Conclusion: arterial chemoembolization can effectively improve the clinical symptoms, improve the quality of life and control tumor growth in patients with advanced bladder cancer with hematuria.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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