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目的:探讨补救性髂内动脉化疗在经尿道膀胱肿瘤切除术(transurethral resection of bladder tumor,TURBT)后证实为肌层浸润性膀胱癌患者中的治疗价值。方法:对34例TURBT患者术后基底部活检及病理结果证实为肌层浸润性的膀胱肿瘤患者行补救性髂内动脉化疗3次,方案为顺铂80mg、表柔吡星50mg、5-氟尿嘧啶1g(或羟基喜树碱30mg)。观察患者肿瘤复发率,Kaplan-Meier法计算总体生存率,肿瘤特异性生存率,无肿瘤复发生存率,并绘制生存曲线。结果:术后经3次补救性髂内动脉化疗及常规膀胱灌注后,29例患者得到保留膀胱(保留膀胱率85.3%),肿瘤复发13例(肿瘤复发率38.2%)。其中,浅表性复发7例,行TURBT治疗;浸润性复发5例,行全膀胱切除术;骨转移1例,行全身化疗。总体生存率:3年69.78%,5年62.03%。肿瘤特异性生存率:3年77.43%,5年68.83%。无肿瘤复发生存率:1年93.10%,2年70.23%,3年46.82%。结论:补救性动脉介入化疗是TURBT术后基底部活检及病理结果证实为肌层浸润性的膀胱肿瘤的良好选择。
Objective: To investigate the therapeutic value of salvage chemotherapy in patients with myasthenic invasive bladder cancer after transurethral resection of bladder tumor (TURBT). Methods: 34 cases of TURBT patients with postoperative basal biopsy and pathological results confirmed myometrial invasive bladder cancer patients undergoing salvage of internal iliac artery chemotherapy three times, the program for cisplatin 80mg, epirubicin 50mg, 5 - fluorouracil 1g (or hydroxycamptothecin 30mg). The tumor recurrence rate was observed. Kaplan-Meier method was used to calculate the overall survival rate, tumor-specific survival rate, tumor-free survival rate, and survival curves. RESULTS: Twenty - nine patients were retained bladder (retained bladder rate 85.3%) and tumor recurred 13 (tumor recurrence rate 38.2%) after 3 treatments of internal iliac artery chemotherapy and conventional intravesical instillation. Among them, superficial recurrence in 7 cases, TURBT treatment; invasive recurrent in 5 cases, underwent cystectomy; bone metastasis in 1 case, underwent systemic chemotherapy. Overall survival rate: 69.78% for 3 years and 62.03% for 5 years. Tumor-specific survival rates were 77.43% for 3 years and 68.83% for 5 years. No tumor recurrence survival rate: 1 year 93.10%, 2 years 70.23%, 3 years 46.82%. CONCLUSIONS: Salvage arterial interventional chemotherapy is a good choice for bladder tumor confirmed by myometrial biopsy and pathological findings after TURBT.