本文選題：化療栓塞 + 晚期�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)動(dòng)脈化療栓塞治療晚期膀胱癌伴血尿患者的臨床療效。方法:回顧分析在2015年3月至2016年12月期間,行膀胱動(dòng)脈或選擇性髂內(nèi)動(dòng)脈化療栓塞治療的31例晚期膀胱癌伴血尿患者。所有患者均經(jīng)病理證實(shí)為尿路上皮癌。腫瘤TNM分期為T3-T4,其中T3期12例,T4期19例。31例患者中男23例,女8例,平均年齡72.0歲。臨床癥狀:全部患者均有不同程度肉眼血尿;6例尿路阻塞,其中4例因血凝塊致排尿困難,均需導(dǎo)尿及持續(xù)膀胱沖洗,2例由腫瘤阻塞輸尿管口致尿路積水,1例經(jīng)皮腎穿刺造瘺術(shù);膀胱刺激征5例,表現(xiàn)為排尿時(shí)尿道針刺感或燒灼感。介入手術(shù)均采用雙側(cè)膀胱動(dòng)脈或選擇性髂內(nèi)動(dòng)脈化療栓塞。使用的動(dòng)脈灌注化療藥物為氟尿嘧啶(500mg~750mg)、吉西他濱(500mg~1000mg)或/和奧沙利鉑(50mg~150mg)。使用的栓塞劑為明膠海綿顆粒、明膠海綿條、個(gè)別患者結(jié)合使用彈簧圈。在患者經(jīng)首次化療栓塞4周后,觀察近期臨床癥狀改善情況及疾病控制率。結(jié)果:動(dòng)脈化療栓塞技術(shù)成功率100%,31例患者在5日內(nèi)血尿均得到有效控制,血尿消失者為90.3%(28/31),剩余3例患者術(shù)后尿色變淡,病情穩(wěn)定,未再行進(jìn)一步治療,4周后無復(fù)發(fā)或病情加重病例;6例尿路阻塞患者中,4例因血凝血塊致排尿困難者均得到緩解;2例尿路積水患者癥狀未見消失,但其中1例經(jīng)治療膀胱腫瘤體積明顯縮小。5例膀胱刺激征患者,術(shù)后均得到緩解。根據(jù)實(shí)體瘤治療療效評(píng)價(jià)標(biāo)準(zhǔn):部分緩解13例,穩(wěn)定11例,進(jìn)展7例,治療有效率為41.9%(13/31),疾病控制率為77.4%(24/31)。結(jié)論:動(dòng)脈化療栓塞可有效改善晚期膀胱癌伴血尿患者的臨床癥狀,提高生活質(zhì)量,并控制腫瘤生長,患者可耐受度強(qiáng),近期療效良好。
[Abstract]:Objective: to evaluate the clinical efficacy of arterial chemoembolization in the treatment of advanced bladder cancer with hematuria. Methods: from March 2015 to December 2016, 31 patients with advanced bladder cancer with hematuria were treated with bladder artery or selective internal iliac artery chemoembolization. All patients were confirmed by pathology as urothelial carcinoma. The TNM stage of the tumor was T3-T4, of which 12 cases were T4 stage. Among them, 23 cases were males and 8 cases were females, with an average age of 72.0 years. Clinical symptoms: all patients had different degrees of gross hematuria in 6 cases of obstruction of urinary tract, among which 4 cases had difficulty in urination caused by blood clots. Two cases of ureteral hydronephrosis caused by tumor obstruction of ureter orifice were treated by percutaneous nephrostomy, and 5 cases of bladder irritation were shown as urethral acupuncture or burning sensation during urination. Interventional surgery was performed with bilateral bladder artery or selective internal iliac artery chemoembolization. The chemotherapeutic agents for arterial infusion were fluorouracil (500 mg / g) and gemcitabine (500 mg / 1 000 mg / g) or / and oxaliplatin (50 mg / g) and / or oxaliplatin (50 mg / g) respectively. The embolization agents used are gelfoam granules, gelatin sponge strips, and coils are used in combination with individual patients. The improvement of clinical symptoms and disease control rate were observed 4 weeks after the first chemoembolization. Results: the successful rate of arterial chemoembolization was 100% and 31 cases were effectively controlled within 5 days. The hematuria disappeared in 90.3% of 31 cases. In 6 patients with urinary tract obstruction, 4 patients with dysuria caused by blood clot were relieved and 2 patients with hydronephrosis did not disappear after 4 weeks of further treatment. But in one case, the volume of bladder tumor was significantly reduced in 5 cases of bladder irritation sign, and all cases were relieved after operation. According to the evaluation criteria for the treatment of solid tumors, there were 13 cases of partial remission, 11 cases of stability, 7 cases of progress, the effective rate of treatment was 41.9% and 13 / 31%, and the disease control rate was 77.4% / 31%. Conclusion: arterial chemoembolization can effectively improve the clinical symptoms, improve the quality of life and control tumor growth in patients with advanced bladder cancer with hematuria.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.14

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