| 摘要: |
| 目的：分析经尿道等离子膀胱肿瘤切除术（PKRBt）中经膀胱黏膜下多点注射吉西他滨（GEM）治疗对非前壁非肌层浸润性膀胱癌（NMIBC）的效果及安全性。方法：48 例 NMIBC 患者均行 PKRBt 术治疗，采用随机数字表法将受试者分为 A 组和 B 组，各 24 例。A 组术中经膀胱黏膜下多点注射 GEM，B 组术后即刻灌注 GEM，比较两组术后毒副作用， 随访肿瘤复发情况及生活质量。结果：A 组 1、1.5、2 年无肿瘤复发生存率分别为 92%、83%、79%，B 组分别为 88%、58%、50% ( log-rank test χ2= 4.216，P= 0.040<0.05），A 组 1、1.5、2 年无 FISH 复发生存率分别为 79%、67%、67%，B组分别为 58%、38%、38% ( log-rank test χ2= 4.110，P= 0.043<0.05）；两组间平均膀胱刺激症状得分不存在显著性差异（P>0.05），均在饮水或对症治疗后缓解；两组毒性反应发生率不存在显著性差异（均P>0.05），多肾功能损伤、胃肠道反应者，给予对症处理后症状均得到缓解，B 组发现 1 例骨髓抑制；随访 1 年，A 组躯体、心理、社会、物质生活四个维度得分均较 B 组高（均P<0.05）。结论：对 NMIBC 患者 PKRBt 术中经膀胱黏膜下多点注射 GEM，疗效好，降低了复发率，耐受性好，安全性高，提高了患者术后的生活质量。 |
| 关键词: PKRBt 吉西他滨 非前壁非肌层浸润性膀胱癌 多点注射 灌注化疗 |
| DOI：10.3969/j.issn.1007-6948.2019.05.010 |
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| 基金项目:南通市科技计划项目（HS149113） |
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| The Efficacy and Safety of Multi-point Injection of Gemcitabine by Bladder Submucosa in PKRBt for Treating Superficial Bladder Cancer |
| LIU Yang,XIA Hou-ping |
| Department of Urology, Tongzhou Chinese Medicine Hospital, Nantong(226300),China |
| Abstract: |
| Objective To analyze the ef?cacy and safety of multi-point injection of gemcitabine by bladder submucosa in PKRBt for treating superficial bladder cancer. Methods Selected 48 cases of patients with super?cial bladder cancer, who were treated by PKRBt, and all were con?rmed as NMIBC by pathology after operation. The selected patients were randomly divided into group A and group B, with 24 cases in each group, Group A was treated with multipoint GEM injection during PKRBt operation, and group B was treated with immediate GEM infusion after PKRBt operation. Toxicity and side effects were compared between the two groups, and tumor recurrence and quality of life were compared during follow-up. Results The survival rates of 1, 1.5 and 2 years without tumor recurrence were 91.7%, 83.3%, 79.2% in group A, while that of group B was 87.5%, 58.3% and 50.0% (log-rank test χ2= 4.216, P= 0.040<0.05), in addition, the recurrence survival rate of 1, 1.5 and 2 years without FISH was 79.2%, 66.7% and 66.7% in group A, while that of group B was 58.3%, 37.5% and 37.5% (log-rank test χ2= 4.110, P= 0.043<0.05); There was no significant difference (P>0.05) in the mean score of bladder irritation between the two groups, and all the patients were relieved after drinking water or symptomatic treatment; There were no signi?cant differences in the incidence of toxic reactions between the two groups (all P>0.05), and the symptoms of multiple renal function injuries and gastrointestinal reactions were relieved after symptomatic treatment, and one of the patients with bone marrow suppression in group B was treated with granulocyte stimulating factor (g-csf),and the blood picture returned to normal; During the 1 -year follow-up after surgery, the scores of the four dimensions of body, mind, society and material life of the patients in group A were higher than those in group B, and the differences were statistically signi?cant (all P <0.05). Conclusion GEM injection through the submucosa of the bladder during PKRBt operation of NMIBC has good curative effect, good tolerance and high safety, reduce recurrence rate, and improved the postoperative quality of life of patients, which is worthy of clinical application. |
| Key words: PKRBt technique gemcitabine non muscle invasive bladder cancer mult-ipoint injection perfusion chemotherapy |
