本文選題：非肌層浸潤性膀胱癌　切入點：免疫治療　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:1觀察及探討經(jīng)尿道膀胱腫瘤電切術(shù)(Transurethral Resection of Bladder Tumor,TUR-Bt)術(shù)中膀胱粘膜下及膀胱腫瘤基底部多點注射免疫制劑白細(xì)胞介素-2(Interleukin-2,IL-2)聯(lián)合術(shù)后即刻膀胱灌注化療藥物吉西他濱(Gemcitabine,GEM)治療及預(yù)防非肌層浸潤性膀胱癌(Non Muscle-Invasive Bladder Cancer,NMIBC)復(fù)發(fā)的臨床效果。2探討具有不同復(fù)發(fā)危險性的膀胱腫瘤患者在應(yīng)用TUR-Bt術(shù)中膀胱粘膜下及腫瘤基底部多點注射IL-2聯(lián)合術(shù)后灌注吉西他濱治療NMIBC與傳統(tǒng)單純行TUR-Bt聯(lián)合吉西他濱灌注的治療后膀胱腫瘤復(fù)發(fā)率比較。方法:收集在2013年2月-2015年2月就診于石家莊市第一醫(yī)院泌尿外科且術(shù)前泌尿系彩超、泌尿系CT及磁共振成像(Magnetic resonance imaging,MRI)提示膀胱逼尿肌未見浸潤的膀胱腫瘤患者,共128例。性別分布為:男性患者76例,女性患者52例。年齡分布在26-81歲,其中30歲以下患者5例,30歲-40歲患者13例,40歲-60歲患者51例,60-80歲患者54例,80歲以上患者5例,平均年齡為58.7歲。腫瘤分布:腫瘤位于膀胱側(cè)壁者47例,后壁者32例,三角區(qū)者20例,頂部者14例,頸部者12例,多部位者3例�；颊咭罁�(jù)嚴(yán)格的納入與排除標(biāo)準(zhǔn)入組,將入組患者依據(jù)隨機(jī)數(shù)字表隨機(jī)分為實驗組和對照組。實驗組患者共68例,手術(shù)中具體實施步驟為先應(yīng)用尿道膀胱鏡及其穿刺針于膀胱粘膜下及腫瘤基底部多點注射IL-2約20針后再改用電切鏡行TUR-Bt術(shù);對照組60例,不應(yīng)用IL-2進(jìn)行多點注射,僅行TUR-Bt術(shù)。術(shù)后將腫瘤組織、腫瘤基底和腫瘤周圍2cm的膀胱粘膜分別送病理學(xué)檢查。兩組患者在病情允許的情況下,均在術(shù)后24小時內(nèi)即刻膀胱灌注化療藥物吉西他濱。所有患者第一年每三個月復(fù)查膀胱鏡檢查及第二年每6個月復(fù)查膀胱鏡檢查時,實驗組需要再次于正常膀胱粘膜下多點注射IL-2,對照組不作任何處理。比較兩組病人于術(shù)后2年隨訪期內(nèi)膀胱腫瘤的復(fù)發(fā)率。若術(shù)后病理結(jié)果回報為浸潤性膀胱癌和原位癌者以及術(shù)后膀胱鏡檢查復(fù)發(fā)者,均退出本實驗研究。統(tǒng)計學(xué)組間計數(shù)資料率的比較采用χ2檢驗或Fisher精確概率法。以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:全部病例在2年隨訪結(jié)束時,實驗組膀胱腫瘤復(fù)發(fā)者12例,復(fù)發(fā)率22%(15/68)。對照組膀胱腫瘤復(fù)發(fā)者25例,復(fù)發(fā)率為42%(25/60)。實驗組復(fù)發(fā)率明顯低于對照組,采用χ2檢驗比較兩組間復(fù)發(fā)率存在差別,χ2值為5.704,P=0.017(P0.05),差異有統(tǒng)計學(xué)意義。將所有入組的膀胱腫瘤患者病歷資料匯總后,回顧性分析實驗數(shù)據(jù),依據(jù)患者術(shù)后病理結(jié)果,參照膀胱腫瘤術(shù)后復(fù)發(fā)危險性評分進(jìn)一步將患者歸類為低危、中危、高危類別后,計算各不同復(fù)發(fā)風(fēng)險類別內(nèi)的實驗組與對照組的膀胱腫瘤復(fù)發(fā)率的差別,得出結(jié)果為:低�；颊咧�,實驗組共19人,復(fù)發(fā)人數(shù)為3例,復(fù)發(fā)率為16%;對照組共21人,復(fù)發(fā)人數(shù)為6例,復(fù)發(fā)率為29%。中�；颊咧�,實驗組共21人,復(fù)發(fā)人數(shù)為6例,復(fù)發(fā)率為29%;對照組共19人,復(fù)發(fā)人數(shù)為9例,復(fù)發(fā)率為47%;高�；颊咧�,實驗組共28人,復(fù)發(fā)人數(shù)為6例,復(fù)發(fā)率為21%;對照組共20人,復(fù)發(fā)人數(shù)為10例,復(fù)發(fā)率為50%。采用χ2檢驗和Fisher精確概率法對各復(fù)發(fā)危險不同類別內(nèi)的實驗組與對照組術(shù)后復(fù)發(fā)率進(jìn)行比較,低�；颊咧�,兩組復(fù)發(fā)率比較P=0.457,P0.05;中危患者中,兩組復(fù)發(fā)率比較P=0.220,P0.05;高�；颊咧�,兩組復(fù)發(fā)率比較P=0.038,P0.05。因此,尚不能認(rèn)為低危及中�；颊邇�(nèi)的實驗組與對照組的復(fù)發(fā)率存在差異(P0.05);而高�；颊邇�(nèi)實驗組膀胱腫瘤復(fù)發(fā)率明顯低于對照組(P0.05),差異有統(tǒng)計學(xué)意義。結(jié)論:1 TUR-Bt術(shù)中膀胱粘膜下及腫瘤基底部多點注射IL-2聯(lián)合術(shù)后灌注吉西他濱對預(yù)防非肌層浸潤性膀胱癌的復(fù)發(fā)具有顯著療效。2此方法尤其對高危非肌層浸潤性膀胱癌患者效果更佳。整個手術(shù)操作簡單,安全性能高,患者不良反應(yīng)少,具有良好的臨床應(yīng)用與推廣價值。
[Abstract]:Objective: To investigate and observe 1 transurethral resection of bladder tumor (Transurethral Resection of Bladder Tumor, TUR-Bt) basal operation in bladder mucous membrane of bladder tumor and multiple point injection of immune agents of interleukin -2 (Interleukin-2, IL-2) instillation of chemotherapy drug gemcitabine after operation (Gemcitabine, GEM) treatment and the prevention of non muscle invasive bladder cancer (Non Muscle-Invasive Bladder Cancer, NMIBC.2) clinical effect on recurrence rate of bladder tumor recurrence in treatment of bladder cancer patients have different risk of recurrence in the bladder in the application of TUR-Bt mucosa and tumor basal multi-point injection of IL-2 combined with postoperative infusion of gemcitabine in the treatment of NMIBC with traditional TUR-Bt combined with gemcitabine after reperfusion. Methods: collected in February 2013 -2015 year in February admitted to the first hospital of Shijiazhuang city in the Department of Urology and preoperative urinary Department of ultrasound, Urinary CT and magnetic resonance imaging (Magnetic resonance imaging, MRI) suggested that patients with bladder tumor bladder detrusor no infiltration, a total of 128 cases. The gender distribution: 76 cases of male patients and 52 female patients. The age distribution at the age of 26-81, among which 5 cases were under 30 years old, 30 years old -40 years old 13 patients 40 -60 years old in 51 patients, 60-80 patients with 54 cases, 5 cases of patients over 80 years old, the average age was 58.7. Tumor distribution: 47 cases of bladder wall tumor in 32 cases, the posterior wall, 20 cases of the Delta region, the top 14 cases, 12 cases of neck, 3 cases part of patients. According to the strict inclusion and exclusion criteria into the group, the patients according to the random number table, randomly divided into experimental group and control group. The experimental group were 68 cases of surgery in the specific implementation steps for the first application of transurethral cystoscope and puncture needle in the basilar part of the bladder mucosa and tumor multi point injection about 20 IL-2 after the needle TUR-Bt electricity cut mirror operation; 60 cases in the control group, no IL-2 application of multiple point injection, only TUR-Bt was performed after operation. The tumor tissue, tumor and tumor of bladder mucosa around the basal 2cm were sent for pathological examination. Two patients in the condition permitting, both in the immediate intravesical chemotherapy gemcitabine 24 hours after surgery. All patients first year every three months by cystoscopy and two years every 6 months by cystoscopy, the experimental group again in normal bladder mucosa under multi-point injection of IL-2, the control group without any treatment. Compared two groups of patients after 2 years follow-up during the period of bladder tumor recurrence rate. If the postoperative pathology results for invasive bladder cancer and carcinoma in situ and postoperative cystoscopy recurrence, were withdrawn from the study. The rate of count data between groups were compared using chi square test or Fisher exact probability 2. In P0.05 the difference was statistically significant. Results: all cases at the end of the 2 years of follow-up, 12 cases of experimental group bladder tumor recurrence, the recurrence rate was 22% (15/68). The control group of 25 cases of bladder tumor recurrence, the recurrence rate was 42% (25/60). The recurrence rate of experimental group was significantly lower than the control group, using chi square 2 test to compare the recurrence rate between two groups are different, 2 x = 5.704, P=0.017 (P0.05), the difference was statistically significant. All the medical records of patients with bladder cancer were pooled, retrospective analysis of experimental data, according to the patient's postoperative pathological results, according to the postoperative recurrence of bladder cancer risk score will be further patients classified as low risk, moderate risk, high risk category, calculate the different risk of recurrence in the experimental group and control group differences in the rate of recurrence of bladder cancer, the results are: low risk patients in the experimental group, a total of 19 people, the number of 3 cases of recurrence, the recurrence rate was 16%; the control group 鍏，

本文編號：1713735