【摘要】：目的探討應(yīng)用經(jīng)尿道電切術(shù)聯(lián)合吉西他濱膀胱灌注治療老年膀胱癌的臨床療效。方法選擇老年膀胱癌患者48例,隨機(jī)分為對(duì)照組和觀察組,兩組患者行經(jīng)尿道電切術(shù),按照腫瘤大小、深淺、內(nèi)外進(jìn)行切除。切除范圍選定:腫瘤以及其基底部周?chē)s2 cm的正常膀胱黏膜組織。術(shù)后所有患者行膀胱灌注,對(duì)照組膀胱灌注液為吡柔比星20 mg+0.9%氯化鈉注射液50 ml,觀察組膀胱灌注液為吉西他濱1.0 g+0.9%氯化鈉注射液50 ml,經(jīng)尿管注入膀胱留置,膀胱灌注每周1次,共6次,以后每2 w 1次,共6次,以后每月1次,共6次,至2個(gè)月1次,直到患者術(shù)后2年。每3~6個(gè)月復(fù)查一次膀胱鏡,發(fā)現(xiàn)可疑腫物可以活檢來(lái)明確。治療結(jié)束后比較兩組患者1年及2年復(fù)發(fā)率、評(píng)價(jià)治療前后患者生活質(zhì)量、中位進(jìn)展時(shí)間、中位生存期以及2年生存率以及記錄治療過(guò)程中不良反應(yīng)發(fā)生情況。結(jié)果觀察組1年及2年復(fù)發(fā)率均低于對(duì)照組(P0.05)。治療后對(duì)照組以及觀察組與兩組患者治療前情況相比均有所改善(P0.05),且觀察組的改善情況相比較對(duì)照組更為明顯(P0.05)。治療后觀察組患者的中位進(jìn)展時(shí)間、中位生存期以及2年生存率均顯著高于對(duì)照組(P0.05)。觀察組總不良反應(yīng)發(fā)生率為270.83%,明顯低于對(duì)照組(337.50%,P0.05)。結(jié)論應(yīng)用經(jīng)尿道電切術(shù)聯(lián)合吉西他濱膀胱灌注治療老年膀胱癌,復(fù)發(fā)率較低,能顯著改善患者生存質(zhì)量及臨床癥狀,提高生存率且不良反應(yīng)相對(duì)較少,值得臨床推廣。
[Abstract]:Objective to investigate the clinical effect of transurethral resection combined with gemcitabine intravesical infusion in the treatment of elderly bladder cancer. Methods 48 elderly patients with bladder cancer were randomly divided into control group and observation group. The patients in the two groups were resected according to the size, depth, inside and outside of the tumor. The resection range was selected: the tumor and the normal bladder mucosa around the base of the tumor for about 2 cm. Bladder perfusion was performed in all patients after operation. Pirarubicin 20 mg 0.9% sodium chloride injection 50 ml, was used in the control group. The bladder perfusion solution was gemcitabine 1.0 g 0.9% sodium chloride injection 50 ml,. Bladder indwelling was injected through catheter once a week for 6 times, then every 2 weeks for 6 times, once a month for 6 times until 2 years after operation. Cystoscopy is reviewed every 3 months and suspicious masses can be biopsied. After treatment, the 1-year and 2-year recurrence rates were compared between the two groups. The quality of life, median progress time, median survival time and 2-year survival rate were evaluated before and after treatment, and the occurrence of adverse reactions during treatment was recorded. Results the recurrence rate of 1 year and 2 years in the observation group was lower than that in the control group (P 0.05). After treatment, the control group and the observation group were improved compared with the two groups before treatment (P 0.05), and the improvement of the observation group was more obvious than that of the control group (P 0.05). After treatment, the median progression time, median survival time and 2-year survival rate of the observation group were significantly higher than those of the control group (P 0.05). The total incidence of adverse reactions in the observation group was 270.83%, which was significantly lower than that in the control group (337.50%, P 0.05). Conclusion transurethral resection combined with gemcitabine intravesical perfusion in the treatment of elderly bladder cancer has a low recurrence rate, which can significantly improve the quality of life and clinical symptoms of the patients, improve the survival rate and have relatively few adverse reactions, which is worthy of clinical promotion.
【作者單位】： 寧波市鄞州人民醫(yī)院寧波大學(xué)附屬鄞州醫(yī)院泌尿外科;
【分類(lèi)號(hào)】：R737.14

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