经尿道电切术联合吉西他滨膀胱灌注治疗老年膀胱癌的临床疗效

发布时间：2019-06-09 12:18

【摘要】：目的探讨应用经尿道电切术联合吉西他滨膀胱灌注治疗老年膀胱癌的临床疗效。方法选择老年膀胱癌患者48例,随机分为对照组和观察组,两组患者行经尿道电切术,按照肿瘤大小、深浅、内外进行切除。切除范围选定:肿瘤以及其基底部周围约2 cm的正常膀胱黏膜组织。术后所有患者行膀胱灌注,对照组膀胱灌注液为吡柔比星20 mg+0.9%氯化钠注射液50 ml,观察组膀胱灌注液为吉西他滨1.0 g+0.9%氯化钠注射液50 ml,经尿管注入膀胱留置,膀胱灌注每周1次,共6次,以后每2 w 1次,共6次,以后每月1次,共6次,至2个月1次,直到患者术后2年。每3~6个月复查一次膀胱镜,发现可疑肿物可以活检来明确。治疗结束后比较两组患者1年及2年复发率、评价治疗前后患者生活质量、中位进展时间、中位生存期以及2年生存率以及记录治疗过程中不良反应发生情况。结果观察组1年及2年复发率均低于对照组(P0.05)。治疗后对照组以及观察组与两组患者治疗前情况相比均有所改善(P0.05),且观察组的改善情况相比较对照组更为明显(P0.05)。治疗后观察组患者的中位进展时间、中位生存期以及2年生存率均显著高于对照组(P0.05)。观察组总不良反应发生率为270.83%,明显低于对照组(337.50%,P0.05)。结论应用经尿道电切术联合吉西他滨膀胱灌注治疗老年膀胱癌,复发率较低,能显著改善患者生存质量及临床症状,提高生存率且不良反应相对较少,值得临床推广。
[Abstract]:Objective to investigate the clinical effect of transurethral resection combined with gemcitabine intravesical infusion in the treatment of elderly bladder cancer. Methods 48 elderly patients with bladder cancer were randomly divided into control group and observation group. The patients in the two groups were resected according to the size, depth, inside and outside of the tumor. The resection range was selected: the tumor and the normal bladder mucosa around the base of the tumor for about 2 cm. Bladder perfusion was performed in all patients after operation. Pirarubicin 20 mg 0.9% sodium chloride injection 50 ml, was used in the control group. The bladder perfusion solution was gemcitabine 1.0 g 0.9% sodium chloride injection 50 ml,. Bladder indwelling was injected through catheter once a week for 6 times, then every 2 weeks for 6 times, once a month for 6 times until 2 years after operation. Cystoscopy is reviewed every 3 months and suspicious masses can be biopsied. After treatment, the 1-year and 2-year recurrence rates were compared between the two groups. The quality of life, median progress time, median survival time and 2-year survival rate were evaluated before and after treatment, and the occurrence of adverse reactions during treatment was recorded. Results the recurrence rate of 1 year and 2 years in the observation group was lower than that in the control group (P 0.05). After treatment, the control group and the observation group were improved compared with the two groups before treatment (P 0.05), and the improvement of the observation group was more obvious than that of the control group (P 0.05). After treatment, the median progression time, median survival time and 2-year survival rate of the observation group were significantly higher than those of the control group (P 0.05). The total incidence of adverse reactions in the observation group was 270.83%, which was significantly lower than that in the control group (337.50%, P 0.05). Conclusion transurethral resection combined with gemcitabine intravesical perfusion in the treatment of elderly bladder cancer has a low recurrence rate, which can significantly improve the quality of life and clinical symptoms of the patients, improve the survival rate and have relatively few adverse reactions, which is worthy of clinical promotion.
【作者单位】：宁波市鄞州人民医院宁波大学附属鄞州医院泌尿外科;
【分类号】：R737.14

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