本文關(guān)鍵詞： 非肌層浸潤性膀胱癌 膀胱灌注化療 吡柔比星 羥基喜樹堿 表柔比星　出處：《延安大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的在泌尿系統(tǒng)中膀胱癌是最常見的惡性腫瘤。根據(jù)癌細(xì)胞侵犯膀胱壁的程度，，非肌層浸潤性膀胱癌（NMIBC）及肌層浸潤性膀胱癌（MIBC）是膀胱癌中兩個主要的類型。非肌層浸潤性膀胱癌在膀胱癌中所占的比例大約是75%～85%，TURBT術(shù)是其主要的治療手段，但是膀胱癌預(yù)后的重大影響因素是術(shù)后腫瘤復(fù)發(fā)。預(yù)防膀胱癌術(shù)后復(fù)發(fā)最重要的方法是在術(shù)后給予膀胱灌注化療，但膀胱灌注化療目前沒有統(tǒng)一的治療方案。本回顧性臨床研究，選擇陜西省人民醫(yī)院泌尿外科2008年1月至2012年3月四年期間的257例非肌層浸潤性膀胱癌患者，均使用TURBT術(shù)治療，術(shù)后定期給予吡柔比星、表柔比星、羥基喜樹堿的膀胱腔內(nèi)灌注化療，將其臨床療效及毒副作用進行比較分析研究，探討經(jīng)尿道膀胱腫瘤切除術(shù)（TURBT）后給予膀胱內(nèi)灌注化療在防止膀胱癌術(shù)后復(fù)發(fā)方面的臨床效果，為膀胱癌患者的臨床治療提供一定的依據(jù)。 方法把257例非肌層浸潤性膀胱癌患者，給予TURBT手術(shù)治療，按照隨機原則將其分成兩大部分，術(shù)后給予膀胱灌注化療并定期復(fù)查及隨訪，嚴(yán)密監(jiān)測患者的并發(fā)癥及復(fù)發(fā)狀況，以術(shù)后兩年為隨訪期限。 一部分是早期膀胱灌注（138例）：Ⅰ組、術(shù)后24h內(nèi)給予吡柔比星膀胱灌注（50例），Ⅱ組、術(shù)后24h內(nèi)給予表柔比星膀胱灌注（41例），Ⅲ組、術(shù)后24h內(nèi)給予羥基喜樹堿膀胱灌注（47例）。 另一部分是常規(guī)膀胱灌注(119例)：A組、術(shù)后1周給予吡柔比星膀胱灌注（43例），B組、術(shù)后1周給予表柔比星膀胱灌注（39例），C組、術(shù)后1周給予羥基喜樹堿膀胱灌注（37例）。 結(jié)果 （1）早期膀胱灌注 ①Ⅰ組、Ⅱ組、Ⅲ組的兩年復(fù)發(fā)率分別為：8.00%、24.39%、25.53%；Ⅰ組和Ⅱ組、Ⅰ組和Ⅲ組的對比均有統(tǒng)計學(xué)意義（P0.05），Ⅱ組和Ⅲ組對比無統(tǒng)計學(xué)意義（P0.05）。 ②三組的血常規(guī)、尿常規(guī)、肝功能、腎功能均無顯著異常，均未發(fā)生膀胱穿孔、創(chuàng)面不愈合及全身嚴(yán)重的不良反應(yīng)。 ③Ⅰ組、Ⅱ組、Ⅲ組的短期膀胱刺激癥狀發(fā)生率分別為：24.00%、21.95%、23.40%，三組比較無統(tǒng)計學(xué)意義（P0.05）。 ④Ⅰ組、Ⅱ組、Ⅲ組的血尿發(fā)生率分別為：12.00%、12.20%、12.77%，三組比較無統(tǒng)計學(xué)意義（P0.05）。 （2）常規(guī)膀胱灌注 ①A組、B組、C組的兩年復(fù)發(fā)率分別為：23.26%、46.15%、29.73%；B組與C組、A組與C組對比都無統(tǒng)計學(xué)意義（P0.05），A組與B組對比有統(tǒng)計學(xué)意義（P0.05）。 ②三組的血常規(guī)、尿常規(guī)、肝功能、腎功能均無明顯異常，均無膀胱穿孔、創(chuàng)面不愈合及全身嚴(yán)重的不良反應(yīng)。 ③A組、B組、C組的短期膀胱刺激癥狀發(fā)生率分別是：18.60%、17.95%、18.92%，三組比較無統(tǒng)計學(xué)意義（P0.05）。 ④A組、B組、C組的血尿發(fā)生率分別是：9.30%、10.26%、8.11%，三組比較無統(tǒng)計學(xué)意義（P0.05）。 （3）早期、常規(guī)膀胱灌注 ①吡柔比星的早期與常規(guī)膀胱灌注、表柔比星的早期與常規(guī)膀胱灌注的兩年復(fù)發(fā)率對比都有統(tǒng)計學(xué)意義（P0.05），羥基喜樹堿的早期與常規(guī)膀胱灌注的兩年復(fù)發(fā)率對比無統(tǒng)計學(xué)意義（P0.05）。 ②吡柔比星的早期與常規(guī)膀胱灌注、表柔比星早期與常規(guī)膀胱灌注、羥基喜樹堿的早期與常規(guī)膀胱灌注的膀胱刺激癥狀對比都無統(tǒng)計學(xué)意義（P0.05）。 ③吡柔比星的早期與常規(guī)膀胱灌注、表柔比星早期與常規(guī)膀胱灌注、羥基喜樹堿的早期與常規(guī)膀胱灌注的血尿情況對比都無統(tǒng)計學(xué)意義（P0.05）。 （4）臨床費用 吡柔比星的價格是189元/支，單次治療費用是567元/次；表柔比星的價格是136元/支，單次治療費用是408元/次；羥基喜樹堿的價格是145元/支，單次治療費用是290元/次。 結(jié)論 （1）吡柔比星早期膀胱灌注化療的臨床療效顯著優(yōu)于吡柔比星常規(guī)膀胱灌注、表柔比星早期膀胱灌注、羥基喜樹堿早期膀胱灌注，是一種有效、安全的防止非膀胱癌術(shù)后復(fù)發(fā)的治療方案，值得進一步推廣應(yīng)用于臨床。 （2）吡柔比星常規(guī)膀胱灌注化療的臨床療效顯著優(yōu)于表柔比星常規(guī)膀胱灌注，羥基喜樹堿與表柔比星的臨床療效無顯著差異。 （3）吡柔比星、表柔比星及羥基喜樹堿的毒副作用無顯著差異且均較小，一般患者都可耐受。 （4）吡柔比星組的治療費用顯著高于表柔比星組及羥基喜樹堿組的治療費用，尤其是羥基喜樹堿的臨床治療費用更具有價格方面的優(yōu)勢，有利于避免患者因經(jīng)濟壓力大而導(dǎo)致治療中斷。
[Abstract]:The purpose of the urinary system in bladder cancer is the most common malignant tumors. According to the degree of cancer cell invasion to the bladder wall, non muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) are the two main types of bladder cancer. Non muscle invasive bladder cancer for bladder the proportion of cancer is about 75% ~ 85%, TURBT surgery is the main treatment, but significant factors affecting the prognosis of bladder cancer is tumor recurrence after operation. The most important method of preventing bladder cancer recurrence after surgery is given intravesical chemotherapy after operation, but there is no bladder perfusion chemotherapy regimen of unity. In this retrospective study, select the Department of Urology of Shaanxi People's Hospital during the four years from January 2008 to March 2012, 257 patients with non muscle invasive bladder cancer patients, using TURBT treatment, postoperative regular pirarubicin, epirubicin, hydroxycamptothecin Intravesical perfusion chemotherapy, the curative effect and side effect of comparative analysis, to explore the transurethral resection of bladder tumor (TURBT) treated with intravesical chemotherapy in the clinical effect of preventing recurrence of bladder cancer after operation, to provide a basis for clinical treatment of patients with bladder cancer.
Methods 257 cases of non muscle invasive bladder cancer patients were treated with TURBT operation. According to the principle of randomization, they were divided into two parts. Postoperative bladder perfusion chemotherapy and regular follow-up and follow-up were performed. The complications and recurrence of patients were closely monitored.
Part of them were early intravesical instillation (138 cases): group I, intravesical instillation of pirarubicin (50 cases) within 24h after operation, group II, intravesical instillation of epirubicin in 41 cases after 24h, group III, intravesical instillation of Hydroxycamptothecin in 24h (47 cases).
The other group was routine bladder irrigation (119 cases), group:A, 1 weeks after the operation, 43 patients were given intravesical instillation of pirarubicin, and group B was given intravesical instillation of epirubicin 1 weeks after operation (39 cases). Group C was given hydroxycamptothecin intravesical instillation (37 cases) 1 weeks after operation.
Result
(1) early instillation of bladder
The recurrence rates of group I, group II and group III were 8%, 24.39% and 25.53%, respectively. There was a significant difference between group I and group II (P0.05), but there was no significant difference between group II and group III (P0.05).
There were no significant abnormalities in blood routine, urine routine, liver function and renal function in the three groups, and no bladder perforation, nonunion of the wound and severe adverse reaction to the whole body were not occurred.
The incidence of short-term bladder irritation in group I, group II and group III were 24%, 21.95%, 23.40%, respectively, and there was no significant difference in the three groups (P0.05).
(4) the incidence of hematuria in group I, group II and group III were 12%, 12.20%, 12.77%, and there was no statistical significance in group three (P0.05).
(2) routine instillation of bladder
(1) the recurrence rates of group A, group B and group C were 23.26%, 46.15% and 29.73%, respectively. There was no statistical difference between group B and group C (P0.05), and there was a significant difference between A group and B group (P0.05).
The three groups had no obvious abnormalities in blood routine, urine routine, liver function and renal function, no bladder perforation, nonunion of wound and serious adverse reaction to the whole body.
(3) the incidence of short-term bladder irritation in group A, group B and group C were 18.60%, 17.95%, 18.92%, respectively, and there was no significant difference between the three groups (P0.05).
(4) the incidence of hematuria in group A, group B and group C were 9.30%, 10.26%, 8.11%, and there was no statistical significance in group three (P0.05).
(3) early instillation of bladder
(1) the early recurrence rate of pirarubicin compared with routine bladder irrigation and the recurrence rate of epirubicin in the early and routine intravesical instillation was statistically significant (P0.05). There was no statistically significant difference between the early recurrence rate of HCPT and the routine bladder perfusion in two years (P0.05).
There was no statistically significant difference between early and routine intravesical instillation of pirarubicin and epirubicin in comparison with routine bladder irrigation and Hydroxycamptothecin in bladder irritation between early and routine intravesical instillation (P0.05).
There was no statistically significant difference between early and routine intravesical instillation of pirarubicin and epirubicin in comparison with routine intravesical instillation and Hydroxycamptothecin in comparison with hematuria in routine and intravesical instillation. (P0.05).
(4) clinical costs
The price of pirarubicin is 189 yuan / branch, the cost of a single treatment is 567 yuan / times, the price of epirubicin is 136 yuan / branch, the cost of single treatment is 408 yuan / time, the price of hydroxycamptothecin is 145 yuan / branch, the cost of single treatment is 290 yuan / time.
conclusion
(1) the clinical curative effect of pirarubicin star early intravesical chemotherapy was significantly better than that of pirarubicin intravesical epirubicin, early intravesical instillation of hydroxycamptothecin, early bladder perfusion, is an effective and safe treatment to prevent non recurrence after resection of bladder cancer, it is worthy of further promotion in clinical application.
(2) the clinical efficacy of pirarubicin routine intravesical instillation chemotherapy is significantly better than that of routine bladder irrigation with epirubicin. There is no significant difference in clinical efficacy between hydroxycamptothecin and epirubicin.
(3) there was no significant difference in side effects between pirubicin, epirubicin and hydroxycamptothecin, and all patients were tolerable.
(4) the cost of treatment of pirarubicin group was significantly higher than that of epirubicin group and hydroxycamptothecin group, especially the cost of clinical treatment of hydroxycamptothecin has more advantages in price, which is beneficial to avoid the interruption of treatment due to the economic pressure.

【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.14

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