本文選題：膀胱癌 + 即刻熱灌注化療　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景和目的:膀胱癌(bladder cancer,BC)好發(fā)于老年人。男性發(fā)病率是女性的3~4倍,發(fā)病率在全球范圍內(nèi)排名惡性腫瘤第九位,致死率列全球男性泌尿生殖系統(tǒng)腫瘤第二位。根據(jù)膀胱癌組織是否浸潤膀胱肌層,分為非肌層浸潤性膀胱癌(non muscle invasive bladder cancer,NMIBC)和肌層浸潤性膀胱癌(muscle invasive bladder cancer,MIBC),二者的手術(shù)方式、預(yù)后、術(shù)后生活質(zhì)量有顯著的不同。在初診的膀胱癌患者中,NMIBC占70%-80%,經(jīng)尿道膀胱腫瘤切除術(shù)(trasnurethral resection of bladder tumor,TURBT)是其首選的治療手段,然而TURBT術(shù)后高復(fù)發(fā)率使患者需要接受定期的膀胱鏡檢查和長期的膀胱灌注化療,生活質(zhì)量大大下降同時也加重了患者的經(jīng)濟負擔(dān),故如何減少NMIBC術(shù)后腫瘤復(fù)發(fā)是當(dāng)今膀胱癌治療中迫切解決的難題。膀胱癌術(shù)后復(fù)發(fā)原因復(fù)雜,TURBT術(shù)后癌細胞殘留與膀胱腔內(nèi)種植是NMIBC復(fù)發(fā)的重要原因之一,故清除TURBT術(shù)后膀胱內(nèi)殘留腫瘤細胞,減少術(shù)后腔內(nèi)種植對預(yù)防NMIBC術(shù)后復(fù)發(fā)具有重要意義。研究表明TURBT術(shù)后膀胱灌注化療的早晚對術(shù)后腫瘤復(fù)發(fā)具有不同的效果,即膀胱灌注化療越早預(yù)防膀胱癌復(fù)發(fā)的效果越好,主要是因為早期的膀胱灌注化療能夠更加有效的殺滅術(shù)后殘留的腫瘤細胞。隨著膀胱癌復(fù)發(fā)機制研究的不斷深入,TURBT術(shù)后進行的灌注時機逐漸被泌尿外科醫(yī)師所重視,即刻膀胱灌注化療因其能夠更加有效地殺滅術(shù)后殘留的腫瘤細胞受到國內(nèi)外專家的推崇。根據(jù)膀胱灌注化療藥物溫度的不同,將其分為常溫膀胱灌注化療和與熱療結(jié)合的膀胱熱灌注化療(hyperthermic intravescial chemotherapy,HIVEC),與常溫灌注化療相比,HIVEC能夠顯著降低NMIBC術(shù)后復(fù)發(fā)率,延長患者的生存時間,但是考慮到TURBT術(shù)后出血、穿孔等并發(fā)癥的發(fā)生,HIVEC的灌注時機一般為術(shù)后3至7天,行TURBT術(shù)后即刻HIVEC的相關(guān)報道較少,本研究回顧性分析44例應(yīng)用BR-TRG-Ⅰ型體腔熱灌注治療系統(tǒng)施行的TURBT術(shù)后吉西他濱即刻膀胱熱灌注化療患者的臨床資料,并與同期吉西他濱常溫即刻灌注化療的患者進行對比,研究TURBT術(shù)后即刻膀胱灌注化療的安全性以及對術(shù)后膀胱癌復(fù)發(fā)率的影響。方法:本研究為回顧性研究,以2015年8月至2016年2月鄭州大學(xué)人民醫(yī)院泌尿外科收治84例非肌層浸潤性膀胱癌患者為研究對象,根據(jù)術(shù)后即刻膀胱灌注方式的不同分為即刻熱灌注組和對照組,其中即刻熱灌注組44例,在行TURBT切除腫瘤后,應(yīng)用BR-TRG-Ⅰ型體腔灌注治療系統(tǒng)行吉西他濱即刻膀胱熱灌注化療;對照組40例,行經(jīng)尿道膀胱腫瘤電切術(shù)后常溫下即刻吉西他濱膀胱灌注化療;之后兩組均按療程持續(xù)膀胱灌注1年。對比分析兩組不同溫度的即刻膀胱灌注化療的不良反應(yīng)、膀胱癌術(shù)后6個月以及12個月的復(fù)發(fā)率。結(jié)果:即刻熱灌注組與對照組的年齡、性別、BMI、伴發(fā)疾病、膀胱腫瘤相關(guān)指標(biāo)比較差異無統(tǒng)計學(xué)意義(P0.05);即刻熱灌注組的腫瘤切除時間、術(shù)后膀胱沖洗時間、術(shù)后留置尿管時間、住院總花費與對照組相近,差異無統(tǒng)計學(xué)意義(P0.05);不良反應(yīng)方面,即刻熱灌注組不良反應(yīng)主要為血尿(25.0%)、尿頻(20.5%)、尿痛(18.2%)、發(fā)熱(5.9%)、胃腸道反應(yīng)(11.8%);對照組發(fā)生率分別為37.5%、27.5%、22.5%、7.5%、10.0%,兩組比較差異無統(tǒng)計學(xué)意義(P0.05);術(shù)后6個月的復(fù)發(fā)率:即刻熱灌注組為11.4%;對照組22.5%,差異無統(tǒng)計學(xué)意義(P0.05),術(shù)后12個月即刻熱灌注組復(fù)發(fā)率為18.1%,對照組為37.5%,兩組比較差異有統(tǒng)計學(xué)意義(P0.05),即刻熱灌注組的無復(fù)發(fā)生存時間為(14.30±0.58)個月,對照組(13.70±0.92)個月,即刻熱灌注組無復(fù)發(fā)生存時間長于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1、應(yīng)用BR-TRG-Ⅰ型體腔熱灌注治療系統(tǒng)行TURBT術(shù)后吉西他濱即刻膀胱熱灌注化療是可行的,不良反應(yīng)與即刻常溫灌注化療相似,應(yīng)用本研究介紹的熱灌注化療實施方法,可保留電切鏡在膀胱內(nèi),實現(xiàn)熱灌注化療過程的可視化,確保即刻膀胱熱灌注化療的順利進行,安全性更好;2、術(shù)后即刻吉西他濱熱灌注化療與常溫即刻膀胱灌注化療相比,可以降低NMIBC術(shù)后的短期復(fù)發(fā)率,延長近期的無復(fù)發(fā)生存時間;但是其預(yù)防復(fù)發(fā)的遠期療效還有待進一步的隨機對照試驗和大宗病例分析進一步證實。
[Abstract]:Background and objective: bladder cancer (bladder cancer, BC) occurs in the elderly. The male incidence rate is 3~4 times higher than women, the incidence of malignant tumors in the world ninth, the death rate among global male urogenital tumor. According to the second bladder cancer tissue infiltration of bladder muscle layer, divided into non muscle invasive bladder cancer (non muscle invasive bladder cancer, NMIBC) and muscle invasive bladder cancer (muscle invasive bladder cancer, MIBC), the prognosis of surgery, two, postoperative quality of life is significantly different in newly diagnosed bladder cancer patients, NMIBC 70%-80%, transurethral resection of bladder resection of the tumor (trasnurethral resection of bladder tumor, TURBT) is the preferred means of treatment, but the TURBT high recurrence rate after operation. Patients need regular cystoscopy and long-term intravesical chemotherapy, quality of life is greatly reduced with the When increasing the economic burden of the patients, so how to reduce tumor recurrence after NMIBC is solved in the treatment of bladder cancer. The causes of postoperative recurrence of bladder cancer after TURBT complex, residual cancer cells and bladder planting is one of the important reasons for the recurrence of NMIBC, so the removal of residual tumor cells after TURBT of bladder in the reduction of postoperative intraluminal implantation has important significance in preventing the recurrence of NMIBC after operation. The results show that the TURBT postoperative bladder perfusion chemotherapy on tumor recurrence after surgery sooner or later has different effect, namely intravesical chemotherapy sooner the better effect of preventing the recurrence of bladder cancer, mainly because of residual bladder perfusion chemotherapy can be more early the effective killing of tumor cells. With the operation mechanism of bladder cancer recurrence continues, time after TURBT perfusion gradually by the Department of Urology physicians attention, immediate intravesical perfusion Because of the chemotherapy can effectively kill residual tumor cells after surgery is praised by domestic and foreign experts. According to the intravesical chemotherapy temperature, which can be divided into normal bladder perfusion chemotherapy and hyperthermia therapy combined with bladder perfusion chemotherapy (hyperthermic intravescial, chemotherapy, HIVEC), compared with normal perfusion chemotherapy, HIVEC significantly reduce the recurrence rate of NMIBC after operation, prolong the survival time of patients, but considering the TURBT postoperative bleeding, perforation and other complications, time is generally HIVEC reperfusion after 3 to 7 days after TURBT reported less immediate HIVEC, this study retrospectively analyzed 44 patients performed using BR-TRG- type cavity thermal perfusion treatment system TURBT surgery clinical data of patients with gemcitabine immediately intravesical perfusion chemotherapy, and compared with normal perfusion chemotherapy gemcitabine immediately in patients. The TURBT after the operation safety of immediate intravesical chemotherapy and the recurrence rate of bladder cancer after operation. Methods: This was a retrospective study from August 2015 to February 2016, the people's Hospital of Zhengzhou University, Department of Urology treated 84 cases of non muscle invasive bladder cancer patients as the research object, according to the different postoperative instillation method for immediate perfusion group and control group, the immediate perfusion group of 44 patients undergoing TURBT after tumor resection, type cavity perfusion treatment system for gemcitabine immediately intravesical perfusion chemotherapy by BR-TRG-; 40 cases in the control group underwent transurethral resection of bladder tumor under the normal temperature after immediate intravesical gemcitabine chemotherapy; group two according to the course of treatment lasted 1 years. Intravesical comparative analysis of adverse reactions of the two groups of different temperature immediate intravesical chemotherapy after resection of bladder cancer, 6 months and 12 months. The recurrence rate : immediate perfusion group and control group in age, gender, BMI, concomitant disease, there was no significant difference between bladder cancer index (P0.05); instant heat perfusion group tumor resection time, bladder irrigation time, indwelling catheter time, total hospitalization costs between the two groups, no significant difference the significance (P0.05); adverse reactions, mainly instant heat perfusion group adverse reactions were hematuria (25%), frequent urination, dysuria (20.5%) (18.2%), fever (5.9%), gastrointestinal reactions (11.8%); the control group was respectively 37.5%, 27.5%, 22.5%, 7.5%, 10%, the difference between the two groups no statistical significance (P0.05); 6 months postoperative recurrence rate: immediate perfusion group was 11.4%; the control group 22.5%, the difference was not statistically significant (P0.05), 12 months after surgery, immediate perfusion group the recurrence rate was 18.1%, the control group was 37.5%, there was significant difference between two groups (P0.05) immediately, perfusion group The recurrence free survival time was (14.30 + 0.58) months, the control group (13.70 + 0.92) months, instant heat perfusion group the recurrence free survival time longer than the control group, the difference was statistically significant (P0.05). Conclusion: 1. The application of BR-TRG- type hyperthermic perfusion system after TURBT immediate intravesical gemcitabine perfusion chemotherapy is feasible and adverse reaction of chemotherapy and immediate perfusion at room temperature is similar to that of the application chemohyperthermia in this paper, can be retained in the bladder Resectoscopy, visualization of perfusion process, ensure immediate bladder perfusion chemotherapy heat smoothly, better safety; 2, immediately after the operation gemcitabine perfusion chemotherapy and normal instillation compared to chemotherapy can reduce the NMIBC postoperative short-term recurrence rate, prolong recurrence free survival in prevention of recurrence; but its long-term efficacy remains to be further randomized controlled Test and large case analysis were further confirmed.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.14

【參考文獻】

相關(guān)期刊論文 前6條

1 劉清源;段小雨;王靈點;陳軍;丁德剛;;非肌層浸潤型膀胱癌術(shù)后膀胱熱灌注化療與常溫灌注化療的療效對比分析[J];中華實用診斷與治療雜志;2017年02期

2 張建軍;蔡維奇;張紹崎;方先林;;吉西他濱與吡柔比星膀胱灌注預(yù)防非肌層浸潤性膀胱癌術(shù)后復(fù)發(fā)的效果比較[J];廣西醫(yī)學(xué);2016年09期

3 彭業(yè)平;馮振華;黃強;邱光進;;術(shù)后吡柔比星膀胱熱灌注治療對預(yù)防淺表性膀胱癌復(fù)發(fā)的療效探討[J];中國實用醫(yī)藥;2016年01期

4 王曉天;宋永勝;崔軍;;TUR-BT術(shù)后行表柔比星、吉西他濱序貫膀胱灌注治療非肌層浸潤性膀胱癌的臨床觀察[J];現(xiàn)代腫瘤醫(yī)學(xué);2012年11期

5 王斌;王行環(huán);崔書中;唐云強;雷鳴;;絲裂霉素膀胱熱灌注化療治療高復(fù)發(fā)淺表性膀胱癌的初步臨床研究[J];臨床泌尿外科雜志;2012年06期

6 曹明;馬辰凱;馬俊;陳海戈;薛蔚;;吉西他濱膀胱灌注治療復(fù)發(fā)性淺表性膀胱腫瘤的安全性與有效性[J];中華腫瘤雜志;2011年05期

相關(guān)博士學(xué)位論文 前1條

1 楊德林;膀胱癌腔內(nèi)種植模型體系的建立及相關(guān)因素的初步探討[D];昆明醫(yī)學(xué)院;2008年

，

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