【摘要】：目的觀察新輔助化療+經(jīng)尿道膀胱腫瘤電切術(shù)(transurethral resection of the bladder tumor,TURBT)治療T2~3N0M0期膀胱癌的療效和預(yù)后,探索該治療方法在肌層浸潤(rùn)性膀胱癌治療中的應(yīng)用價(jià)值。方法選取2011年10月~2014年12月間我院收治的61例T2~3N0M0期膀胱癌患者。入院時(shí)根據(jù)患者意愿及身體條件將患者分為2組,選擇經(jīng)3周期新輔助化療及TURBT治療后獲得腫瘤完全緩解的25例患者作為觀察組;選擇同時(shí)期經(jīng)根治性膀胱切除術(shù)治療的36例膀胱癌T2~3N0M0期患者選作為對(duì)照組。觀察新輔助化療+TURBT治療方案的療效及安全性、計(jì)算累積生存率并與對(duì)照組進(jìn)行統(tǒng)計(jì)學(xué)比較。結(jié)果新輔助化療前腫瘤最大直徑平均3.43±1.18cm,最小直徑平均2.31±0.66cm;化療后最大直徑平均2.74±1.13cm;最小直徑平均1.58±0.38cm。新輔助化療期間主要不良反應(yīng)為骨髓抑制及消化道反應(yīng),給予對(duì)癥治療后均不同程度緩解,未出現(xiàn)嚴(yán)重化療不良反應(yīng)而導(dǎo)致化療中斷或患者死亡�；颊唠S訪18~54個(gè)月,觀察組25例患者局部復(fù)發(fā)7例,遠(yuǎn)處轉(zhuǎn)移2例。局部復(fù)發(fā)7例患者中淺表性復(fù)發(fā)3例,肌層浸潤(rùn)性復(fù)發(fā)4例。至隨訪截止日期,觀察組1年、2年、3年累積生存率分別為95.8%、85.7%、78.5%;對(duì)照組1年、2年、3年累積生存率分別為97.2%、90.6%、81.0%。兩組之間累積生存率差異無(wú)顯著統(tǒng)計(jì)學(xué)意義(P=0.720)。結(jié)論1.肌層浸潤(rùn)性膀胱癌術(shù)前使用新輔助化療可以有效縮小腫瘤并使腫瘤降期,更有利于術(shù)中腫瘤的完整切除,提高了患者保留膀胱的可能。2.新輔助化療聯(lián)合TURBT治療肌層浸潤(rùn)性膀胱癌可以獲得與傳統(tǒng)根治性手術(shù)相似的生存率,并且患者膀胱功能得以保存,生活質(zhì)量得到顯著改善。
[Abstract]:Objective to observe the curative effect and prognosis of neoadjuvant chemotherapeutic transurethral resection of bladder tumor (transurethral resection of the bladder tumor,TURBT) in the treatment of bladder cancer in T2~3N0M0 stage, and to explore the value of this treatment in the treatment of myometrial invasive bladder cancer. Methods from October 2011 to December 2014, 61 patients with T2~3N0M0 stage bladder cancer were treated in our hospital. On admission, the patients were divided into two groups according to the wishes and physical conditions of the patients. 25 patients with complete remission after 3 cycles of neoadjuvant chemotherapy and TURBT were selected as the observation group. Thirty-six patients with bladder cancer at T2~3N0M0 stage were selected as control group after radical cystectomy in the same period. To observe the efficacy and safety of neoadjuvant chemotherapy TURBT regimen and to calculate the cumulative survival rate and compare it with that of the control group. Results the mean maximum diameter of neoadjuvant chemotherapy was 3.43 鹵1.18 cm, the minimum diameter was 2.31 鹵0.66 cm, the mean maximum diameter of neoadjuvant chemotherapy was 2.74 鹵1.13 cm and the minimum diameter was 1.58 鹵0.38 cm. The main adverse reactions during neoadjuvant chemotherapy were bone marrow depression and digestive tract reaction. The patients were followed up for 18 ~ 54 months. In the observation group, there were 7 cases of local recurrence and 2 cases of distant metastasis. Among 7 cases of local recurrence, 3 cases were superficial recurrence and 4 cases were myometrial infiltrative recurrence. To the deadline of follow-up, the cumulative survival rate of one year, two years and three years in the observation group was 95.85.7and 78.50.The cumulative survival rate of the control group was 97.2%, 90.6% and 81.0%, respectively. There was no significant difference in cumulative survival rate between the two groups (P0. 720). Conclusion 1. Preoperative neoadjuvant chemotherapy for intramuscular invasive bladder cancer can effectively reduce the tumor and reduce the stage of the tumor, which is more conducive to complete resection of the tumor during the operation, and increases the possibility of bladder retention. 2. Neoadjuvant chemotherapy combined with TURBT in the treatment of intramuscular invasive bladder cancer can obtain a survival rate similar to that of traditional radical surgery, and the bladder function is preserved and the quality of life is significantly improved.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.14

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1 高平;趙玉保;郝海峰;陳元貴;周俊紅;安瑞;閆富平;李生才;;經(jīng)尿道膀胱腫瘤二次電切術(shù)的臨床意義[J];中國(guó)藥物與臨床;2013年07期

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