摘要
目的探讨经尿道等离子膀胱肿瘤切除（plasmakinetic resection of bladder tumor,PKRBt）术中经膀胱黏膜下多点注射吉西他滨治疗非前壁的非肌层浸润性膀胱癌（non muscle-invasive bladder cancer,NMIBC）的临床疗效。方法我院2012年1月-2013年10月经膀胱镜下组织活检病理确诊的非前壁的NMIBC患者90例,按随机数字表法分为观察组和对照组,每组45例。对照组行PKRBt,观察组PKRBt术中经膀胱黏膜下多点注射吉西他滨5 ml（25 mg/ml）。2组术后维持膀胱灌注化疗相同。比较2组术后肿瘤复发率,免疫荧光杂交技术检测（fluorescence in situ hybridization,FISH）阳性复发率及术后不良反应发生率,并用生活质量综合评定问卷（Generic Quality of Life Inventory-74,GQOLI-74）对2组治疗后1年的生活质量做出评价。结果 1、1.5、2年无肿瘤复发生存率观察组分别为93.3%、91.1%,89.9%,对照组为88.9%、75.1%,65.7%（log rankχ^2=6.476,P=0.011）;1、1.5、2年无FISH复发生存率观察组分别为93.3%、86.7%,84.4%,对照组为91.1%、68.3%,61.2%（log rankχ^2=5.883,P=0.015）。术后2组均有不同程度的尿路刺激症状、轻度肾功能损伤及胃肠道反应,2组不良反应发生率无显著性差异（P〉0.05）。观察组治疗1年后躯体功能、心理功能、社会功能、物质生活四个维度得分均较对照组高（P〈0.05）。结论对于非前壁NMIBC,PKRBt术中经膀胱黏膜下多点注射吉西他滨可以显著降低复发率,不良反应少,安全性高,术后生活质量高,值得在临床推广应用。
Objective To explore clinical effects of bladder submucosal multi-point injections of gemcitabine in plasmakinetic resection of bladder tumor（ PKRBt） for treating non-anterior wall and non-muscle-invasive bladder cancer. Methods A total of 90 cases of patients with cystoscope biopsy confirmed non-anterior wall and non-muscle-invasive bladder cancer receiving treatment in our hospital from January 2012 to October 2013 were enrolled. They were randomly divided into two groups by using the random number table. One is the observation group and the other is the control group,with 45 cases in each group. The control group received PKRBt,while the observation group was given multi-point injections of gemcitabine 5 ml（ 25 mg / ml） during PKRBt. Both groups were given maintained postoperative bladder perfusion chemotherapy. The postoperative tumor recurrent rate,fluorescence in situ hybridization（ FISH） recurrent rate and the occurrence of postoperative adverse reactions were compared between the two groups. Besides,the quality of life of the two groups of patients were evaluated by using the Generic Quality of Life Inventory-74（ GQOLI-74） after one year of treatment. Results The 1-year,1. 5-year and 2-year tumor free rates in the observation group were 93. 3%,91. 1%,and 89. 9%,while in the control group were 88. 9%,75. 1%,and 65. 7%（ log rank χ^2= 6. 476,P = 0. 011）. The 1-year,1. 5-year and2-year FISH tumor free rates in the observation group were 93. 3%,86. 7%,and 84. 4%,while in the control group were 91. 1%,68. 3%,and 61. 2%（ log rank χ^2= 5. 883,P = 0. 015）. There were different degrees of postoperative urinary irritation,mild renal injury and gastrointestinal reactions in both groups,and there were no significant differences in the incidence of adverse reactions between the two groups（ P〉0. 05）. In the observation group,the scores of physical function,psychological function,social function and material life were significantly higher than those in the control group after 1 year of tre
出处
《中国微创外科杂志》
CSCD
北大核心
2016年第8期689-693,共5页
Chinese Journal of Minimally Invasive Surgery
基金
国家自然科学基金(8137274,81172421)
