本文選題：膀胱癌 + 絲裂霉素-C��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：研究目的探討膀胱腫瘤術(shù)后冬凌草膀胱熱灌治療在預(yù)防高危非肌層浸潤性膀胱癌復(fù)發(fā)方面的有效性及安全性,為臨床診療提供有力證據(jù)。研究對象和方法回顧性分析我院2013年1月—2016年1月收治的高危非肌層浸性膀胱癌(NMIBC)患者80例,均在行經(jīng)尿道膀胱腫瘤電切術(shù)(TURBt)或膀胱部分切除術(shù)后,經(jīng)病理報告證實為尿路移行上皮細(xì)胞癌,病理分期為非肌層浸潤性癌。術(shù)前患者心、肺、肝、腎功能和血常規(guī)檢查無明顯異常。按照患者或其家屬的意見,患者術(shù)后分為兩組,冬凌草熱灌注組為A組40例,男30例,女10例,年齡34-97歲,均值63歲;術(shù)后病理回示Tis 3例,Ta期13例,T1期24例;病理分級按照WHO 2004膀胱尿路上皮癌惡性程度分級系統(tǒng),低級別尿路上皮癌9例,高級別尿路上皮癌31例;腫瘤單發(fā)9例,多發(fā)31例;均行冬凌草膀胱熱灌注治療。絲裂霉素灌注組為B組共40例,男31例,女9例;年齡22-78歲,均值57歲;術(shù)后病理回示Tis 3例,Ta 10例,T1 27例;病理分級低級別尿路上皮癌8例,高級別尿路上皮癌32例;腫瘤單發(fā)14例,多發(fā)26例,術(shù)后均行絲裂霉素膀胱灌注化療輔助治療。綜合兩組患者的臨床材料和病理結(jié)果,統(tǒng)計學(xué)分析其構(gòu)成差別無顯著性(P0.05)。術(shù)后對納入研究的病例進(jìn)行隨訪,統(tǒng)計兩組病人在隨訪觀察期間復(fù)發(fā)率、進(jìn)展率及不良反應(yīng)發(fā)生狀況,評價該方法的臨床安全性及有效性。結(jié)果隨訪3-45個月,中位時間16個月,未出現(xiàn)由于嚴(yán)重不良反應(yīng)而退出研究的患者。A組復(fù)發(fā)率為32.5%(13/40),B組復(fù)發(fā)率為55%(22/40),兩組復(fù)發(fā)率差異有顯著性(χ2=4.11,P=0.0430.05),A組復(fù)發(fā)率顯著低于B組。A組進(jìn)展率為17.5%(7/40),B組進(jìn)展率為37.5%(15/40),兩組進(jìn)展率差異亦有顯著性(χ2=4.013,P=0.0450.05),A組進(jìn)展率顯著低于B組。根據(jù)患者膀胱癌復(fù)發(fā)時間的分布,通過Kaplan-Meier分析兩組患者術(shù)后無復(fù)發(fā)生存率,A、B組的中位未復(fù)發(fā)期分別為34個月和23個月,兩組腫瘤未復(fù)發(fā)率比較有統(tǒng)計學(xué)差異(log-rank檢驗χ2=4.11,P=0.040.05)。兩組患者在治療過程的不良反應(yīng)主要有膀胱炎(表現(xiàn)為尿頻、尿急、尿痛等膀胱刺激癥狀)、肉眼及鏡下血尿、膀胱痙攣疼痛,未出現(xiàn)嚴(yán)重的并發(fā)癥患者。A組治療后不良反應(yīng)共計8例,B組不良反應(yīng)共計10例,兩組比較差異無顯著性(χ2=0.28,P0.05)。冬凌草液熱療可以有效的預(yù)防高危NMIBC術(shù)后復(fù)發(fā)與進(jìn)展。結(jié)論膀胱腫瘤術(shù)后冬凌草膀胱熱灌注治療作為新的術(shù)后輔助治療,用于預(yù)防膀胱腫瘤復(fù)發(fā)安全有效。相比以往常溫下MMC灌注化療,該方法的復(fù)發(fā)率和進(jìn)展率都較低,且不增加不良反應(yīng)發(fā)生率。故認(rèn)為對于高危NMIBC患者,術(shù)后冬凌草膀胱熱灌注預(yù)防腫瘤復(fù)發(fā)效果理想,值得臨床推廣。
[Abstract]:Objective to investigate the efficacy and safety of oridox in preventing the recurrence of high risk non-myometrial invasive bladder cancer after operation of bladder neoplasms, and to provide strong evidence for clinical diagnosis and treatment. Participants and methods A retrospective analysis of 80 cases of high risk NMIBC patients with non-myogenic bladder cancer treated in our hospital from January 2013 to January 2016 was performed after transurethral resection of bladder tumor (TURBt) or partial cystectomy. It was confirmed by pathology as transitional epithelial cell carcinoma of urinary tract and non-myometrial invasive carcinoma. There were no significant abnormalities in heart, lung, liver, kidney function and blood routine examination before operation. According to the opinion of the patients or their families, the patients were divided into two groups: group A: group A (40 cases), male 30 cases, female 10 cases, age 34 to 97 years old, mean 63 years old, postoperative pathology showed 3 cases of Tis, 13 cases of stage T 1 and 24 cases of T 1 stage. According to the WHO 2004 classification system, 9 cases of low grade urothelial carcinoma, 31 cases of high grade urothelial carcinoma, 9 cases of single tumor and 31 cases of multiple tumors were treated with oridox bladder hyperperfusion. There were 40 cases in group B (male 31, female 9; age 22-78 years, mean 57 years), 3 cases with Tis, 10 cases with T 1, 27 cases with T 1, 8 cases with low grade urothelial carcinoma and 32 cases with high grade urothelial carcinoma. There were 14 cases of single tumor and 26 cases of multiple tumor. All patients were treated with mitomycin intravesical chemotherapy after operation. According to the clinical data and pathological results of the two groups, there was no significant difference in the constitution of the two groups (P 0.05). The recurrence rate, progression rate and adverse reaction of the two groups were analyzed and the clinical safety and effectiveness of the method were evaluated. Results the follow-up period was 3-45 months and the median time was 16 months. The recurrence rate of group A was 32.5% and the recurrence rate of group B was 55 22 / 40%. The recurrence rate of group A was significantly lower than that of group B. the rate of progression in group B was 37.515% -40%. There was a significant difference between the two groups (蠂 2 4.11P 0.0430.05 0. 05). The development rate of group A was significantly lower than that of group B (蠂 2 + 4.013). According to the distribution of recurrence time of bladder cancer, the median non-recurrence period in group A and B was 34 months and 23 months respectively by Kaplan-Meier analysis. There was significant difference between the two groups by log-rank test (蠂 ~ 2 4.11). The adverse reactions of the two groups were mainly cystitis (symptoms of bladder irritation such as frequency of urination, urinal pain, hematuria under naked eye and microscope, pain in bladder spasm, etc.) In group A, there were 8 cases of adverse reactions in group B and 10 cases in group B, there was no significant difference between the two groups (蠂 2 0.28 P 0.05). The thermotherapy of oridox can effectively prevent the recurrence and progress of high-risk NMIBC. Conclusion as a new adjuvant treatment of bladder tumor, oridox is safe and effective in preventing the recurrence of bladder tumor. The recurrence rate and progression rate of this method were lower than that of MMC infusion chemotherapy at normal temperature, and the incidence of adverse reactions was not increased. It is considered that for high risk NMIBC patients, the effect of oridox bladder hyperperfusion for preventing tumor recurrence is ideal and worthy of clinical promotion.
【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
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本文編號：1990777