本文選題：膀胱腫瘤　切入點(diǎn)：吡柔比星（THP）　出處：《青海大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過(guò)對(duì)吡柔比星(pirarubicin,THP)、羥基喜樹堿(hydroxycamptothecin,HCPT)絲裂霉素C(mitomycin C,MMC)預(yù)防淺表性膀胱癌(SBC)術(shù)后復(fù)發(fā)效果的臨床觀察分析，旨在更好地探究其臨床意義。 方法：選取初發(fā)膀胱癌患者共141例，其中THP組51例，HCTP組47例，MMC組43例。以上三組分別于TURBT或膀胱部分切除術(shù)后的24小時(shí)內(nèi)或即刻行THP、HCPT和MMC的灌注治療。膀胱灌注可通過(guò)留置的導(dǎo)尿管進(jìn)行。一周以后再次對(duì)以上三組患者行膀胱內(nèi)藥物灌注。灌注前作如下準(zhǔn)備：1.囑患者排空尿液；2.常規(guī)消毒；3.予以留置導(dǎo)尿。準(zhǔn)備完善后行藥物灌注，THP在膀胱內(nèi)保留30分鐘，HCPT和MMC在膀胱內(nèi)保留2小時(shí)。在此期間THP組每10分鐘囑灌注后的患者改變體位（仰、兩側(cè)、俯）一次，HCPT組、MMC組每30分鐘囑灌注后的患者改變一次體位。藥物灌注方案：先囑患者每周一次行藥物灌注，連續(xù)8周，以后每月1次，連續(xù)10個(gè)月�？偦煏r(shí)間為52周。在一年內(nèi)囑灌注后所有患者每3個(gè)月行一次檢查，包括血液分析檢查、尿液分析檢查、肝腎功能檢查、膀胱鏡檢查。1年之后每半年復(fù)查一次。在每次膀胱灌注后，都認(rèn)真觀察并記錄藥物引起的副反應(yīng)情況，如：血尿、膀胱刺激癥狀等。通過(guò)病理檢查來(lái)確定復(fù)查過(guò)程中發(fā)現(xiàn)的可疑病變是否為術(shù)后復(fù)發(fā)的膀胱癌組織。 結(jié)果：對(duì)術(shù)后行膀胱灌注的所有患者隨訪24個(gè)月的結(jié)果如下：三組患者術(shù)后6個(gè)月內(nèi)總復(fù)發(fā)率為7.80%，其中THP組復(fù)發(fā)率為5.88%，HCTP組復(fù)發(fā)率為4.26%、MMC組復(fù)發(fā)率為13.96%，差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）；：三組患者術(shù)后12個(gè)月內(nèi)總復(fù)發(fā)率為14.1%，其中THP組為9.80%、HCTP組為8.51%、MMC組為25.58%，，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；以上三組患者術(shù)后24個(gè)月內(nèi)的腫瘤總復(fù)發(fā)率為18.44%。其中THP組復(fù)發(fā)率為13.73%、HCTP組復(fù)發(fā)率為10.64%、MMC組復(fù)發(fā)率為32.56%，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）。三組患者注期間不良發(fā)應(yīng)總發(fā)生率為25.85%。在灌注期間膀胱刺激癥狀的發(fā)生率為THP組為17.37%，HCTP組為12.00%，MMC組35.56%，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；血尿的發(fā)生率THP組為1.92%，HCTP組為4.00%，MMC組8.89%，差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。 結(jié)論：THP、HCPT行膀胱灌注預(yù)防SBC復(fù)發(fā)效果明顯優(yōu)于MMC，且不良反應(yīng)發(fā)生率低，值得臨床推廣應(yīng)用。
[Abstract]:Objective: to evaluate the clinical effect of pirarubicinus pirarubicinus (THPX), hydroxycamptothecin (HCPT) mitomycin (MMC) on the recurrence of superficial bladder cancer (SBC) after operation, in order to explore its clinical significance. Methods: 141 patients with primary bladder cancer were selected. Among them, 51 cases in THP group, 47 cases in MMC group, 43 cases in MMC group. The above three groups were perfused with THPHCPT and MMC within 24 hours or immediately after TURBT or partial cystectomy. Bladder perfusion could be done by indwelling catheter after one week. Once again, the above three patients were given intravesical drug perfusion. Before perfusion, the following preparations were made: 1. Ask the patient to empty the urine. 2. Routine disinfecting. 3. Place catheterization. After the preparation is completed, the drug will be infused with THP for 30 minutes to retain HCPT and MMC in the bladder. Stay in bladder for 2 hours. During this period, the patients in the THP group changed their posture after instillation every 10 minutes. The patients in the MMC group changed their posture once every 30 minutes. Ten consecutive months. The total chemotherapy time was 52 weeks. After one year of perfusion, all patients were examined every 3 months, including blood analysis, urine analysis, liver and kidney function examination. Cystoscopy. After one year, every six months recheck. After each bladder perfusion, carefully observe and record the side effects caused by drugs, such as: hematuria, Bladder irritation symptoms and so on. Pathological examination to determine whether the suspicious lesions found during the review are recurrent bladder cancer tissue. Results: the results of 24 months follow-up for all patients undergoing bladder perfusion were as follows: the total recurrence rate of the three groups was 7.80 within 6 months after operation, of which the recurrence rate of the THP group was 5.88 and the recurrence rate of the THP group was 4.26. The recurrence rate of the MMC group was 13.96 and there was no statistical difference. The total recurrence rate of the three groups was 14.1% within 12 months after operation, and that in the THP group was 8.51%, 25.58 (P < 0.05), and 18.44% in the THP group (P < 0.05), and the recurrence rate was 18.44% in the THP group (P < 0.05), and the total recurrence rate was 18.44% in the above three groups (P < 0.05), and the recurrence rate was 18.44% in the THP group (P < 0.05), and the total recurrence rate was 18.44% in the THP group (P < 0.05), and the total recurrence rate was 18.44% in the THP group. The recurrence rate of HCTP group was 10.64 and the recurrence rate of MMC group was 32.56, the difference was statistically significant (P < 0.05). The total incidence of adverse hair response in the three groups was 25.85. The incidence of bladder irritation in THP group was 17.37 and 12.00 in THP group, which was 35.565.The difference was statistically significant. The incidence of hematuria in the THP group was 4.00 and 8.89, respectively. There was no significant difference between the two groups (P > 0.05). Conclusion the effect of bladder instillation of HCPT in the prevention of SBC recurrence is better than that in MMC, and the incidence of adverse reactions is low, so it is worth popularizing and applying in clinic.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.14

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 巢月根;羥基喜樹鹼膀胱灌注治療和預(yù)防膀胱腫瘤復(fù)發(fā)的觀察[J];上海鐵道大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);1997年02期

2 趙立明,印強(qiáng),李炯,趙成朱;羥基喜樹堿膀胱灌注化療預(yù)防膀胱癌術(shù)后復(fù)發(fā)[J];現(xiàn)代腫瘤醫(yī)學(xué);2003年02期

3 李彥生;李長(zhǎng)福;陳永勝;;吡柔比星、絲裂霉素和羥基喜樹堿抑制膀胱癌最佳組合的研究[J];實(shí)用腫瘤學(xué)雜志;2007年04期

4 郎建華;吡柔比星治療膀胱癌臨床應(yīng)用現(xiàn)狀[J];中國(guó)腫瘤臨床與康復(fù);2003年03期

5 陳曉,李賢羿,韓志友,管德林,高居忠;TUR-Bt術(shù)后膀胱內(nèi)灌注吡柔比星預(yù)防復(fù)發(fā)的臨床觀察[J];中國(guó)腫瘤臨床;2001年06期

6 魏礦榮,陳振雄,梁智恒,何方方,林茂合,歐小文;中山市1970～1999年膀胱癌發(fā)病趨勢(shì)分析[J];中國(guó)腫瘤;2005年04期

7 葉敏,舒暢,馬邦一,陳建華,張良;吡柔比星誘導(dǎo)膀胱癌細(xì)胞凋亡的實(shí)驗(yàn)研究及預(yù)防膀胱癌術(shù)后復(fù)發(fā)的效果[J];中華泌尿外科雜志;2002年01期

8 劉兆偉,王澤佳;吡柔比星膀胱灌注預(yù)防淺表性膀胱癌術(shù)后復(fù)發(fā)[J];中國(guó)基層醫(yī)藥;2001年06期

9 許新軒;王彥業(yè);孫山英;白衛(wèi)云;;手術(shù)治療膀胱癌的臨床研究與分析[J];中國(guó)實(shí)用醫(yī)藥;2007年25期

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