新辅助化疗联合经尿道膀胱肿瘤电切术治疗肌层浸润性膀胱癌疗效分析

发布时间：2019-01-27 10:30

【摘要】：目的观察新辅助化疗+经尿道膀胱肿瘤电切术(transurethral resection of the bladder tumor,TURBT)治疗T2~3N0M0期膀胱癌的疗效和预后,探索该治疗方法在肌层浸润性膀胱癌治疗中的应用价值。方法选取2011年10月~2014年12月间我院收治的61例T2~3N0M0期膀胱癌患者。入院时根据患者意愿及身体条件将患者分为2组,选择经3周期新辅助化疗及TURBT治疗后获得肿瘤完全缓解的25例患者作为观察组;选择同时期经根治性膀胱切除术治疗的36例膀胱癌T2~3N0M0期患者选作为对照组。观察新辅助化疗+TURBT治疗方案的疗效及安全性、计算累积生存率并与对照组进行统计学比较。结果新辅助化疗前肿瘤最大直径平均3.43±1.18cm,最小直径平均2.31±0.66cm;化疗后最大直径平均2.74±1.13cm;最小直径平均1.58±0.38cm。新辅助化疗期间主要不良反应为骨髓抑制及消化道反应,给予对症治疗后均不同程度缓解,未出现严重化疗不良反应而导致化疗中断或患者死亡。患者随访18~54个月,观察组25例患者局部复发7例,远处转移2例。局部复发7例患者中浅表性复发3例,肌层浸润性复发4例。至随访截止日期,观察组1年、2年、3年累积生存率分别为95.8%、85.7%、78.5%;对照组1年、2年、3年累积生存率分别为97.2%、90.6%、81.0%。两组之间累积生存率差异无显著统计学意义(P=0.720)。结论1.肌层浸润性膀胱癌术前使用新辅助化疗可以有效缩小肿瘤并使肿瘤降期,更有利于术中肿瘤的完整切除,提高了患者保留膀胱的可能。2.新辅助化疗联合TURBT治疗肌层浸润性膀胱癌可以获得与传统根治性手术相似的生存率,并且患者膀胱功能得以保存,生活质量得到显著改善。
[Abstract]:Objective to observe the curative effect and prognosis of neoadjuvant chemotherapeutic transurethral resection of bladder tumor (transurethral resection of the bladder tumor,TURBT) in the treatment of bladder cancer in T2~3N0M0 stage, and to explore the value of this treatment in the treatment of myometrial invasive bladder cancer. Methods from October 2011 to December 2014, 61 patients with T2~3N0M0 stage bladder cancer were treated in our hospital. On admission, the patients were divided into two groups according to the wishes and physical conditions of the patients. 25 patients with complete remission after 3 cycles of neoadjuvant chemotherapy and TURBT were selected as the observation group. Thirty-six patients with bladder cancer at T2~3N0M0 stage were selected as control group after radical cystectomy in the same period. To observe the efficacy and safety of neoadjuvant chemotherapy TURBT regimen and to calculate the cumulative survival rate and compare it with that of the control group. Results the mean maximum diameter of neoadjuvant chemotherapy was 3.43 卤1.18 cm, the minimum diameter was 2.31 卤0.66 cm, the mean maximum diameter of neoadjuvant chemotherapy was 2.74 卤1.13 cm and the minimum diameter was 1.58 卤0.38 cm. The main adverse reactions during neoadjuvant chemotherapy were bone marrow depression and digestive tract reaction. The patients were followed up for 18 ~ 54 months. In the observation group, there were 7 cases of local recurrence and 2 cases of distant metastasis. Among 7 cases of local recurrence, 3 cases were superficial recurrence and 4 cases were myometrial infiltrative recurrence. To the deadline of follow-up, the cumulative survival rate of one year, two years and three years in the observation group was 95.85.7and 78.50.The cumulative survival rate of the control group was 97.2%, 90.6% and 81.0%, respectively. There was no significant difference in cumulative survival rate between the two groups (P0. 720). Conclusion 1. Preoperative neoadjuvant chemotherapy for intramuscular invasive bladder cancer can effectively reduce the tumor and reduce the stage of the tumor, which is more conducive to complete resection of the tumor during the operation, and increases the possibility of bladder retention. 2. Neoadjuvant chemotherapy combined with TURBT in the treatment of intramuscular invasive bladder cancer can obtain a survival rate similar to that of traditional radical surgery, and the bladder function is preserved and the quality of life is significantly improved.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

【参考文献】