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目的:探讨TURis-Bt术前膀胱灌注表柔比星治疗非肌层浸润性膀胱癌(NMIUC)的临床疗效。方法:选取2008年9月至2012年1月潍坊市中医院和上海交通大学附属第一人民医院泌尿外科收治的76例NMIUC患者,并将其随机分为观察组(TURis-Bt术前膀胱灌注表柔比星+术后常规灌注组)41例和对照组(TURis-Bt术后常规表柔比星膀胱灌注组)35例。灌注前将50mg表柔比星溶解于50ml 5%葡萄糖注射液,术前膀胱保留灌注30分钟后膀胱镜观察肿瘤组织及周围膀胱粘膜染色情况,将表柔比星橙染的膀胱粘膜活检并行TURis-Bt;对照组取瘤旁2 cm处及其他部位膀胱粘膜多点活检。比较两组的原位癌(CIS)、非典型性增生及腺性膀胱炎等病变检出率和术后肿瘤的复发率。结果:观察组患者瘤旁膀胱粘膜橙染56处,其中7处病理证实为膀胱原位癌、5处为非典型性增生、11处为腺性膀胱炎;对照组患者膀胱原位癌1处、非典型性增生3处、腺性膀胱炎2处,两组病变阳性率分别为41.1%(23/56)和13.4%(17/127),差异有显著统计学意义(P<0.01)。观察组与对照组术后2年内肿瘤复发率分别为10.3%(4/39)和35.3%(12/34),差异有统计学意义(P<0.05)。结论:TURis-Bt术前膀胱灌注表柔比星能提高NMIUC病变的早期检出率并降低肿瘤术后复发率。
Objective: To investigate the clinical efficacy of TURIS-Bt preoperative intravesical instillation epirubicin in the treatment of non-muscle invasive bladder cancer (NMIUC). Methods: A total of 76 patients with NMIUC admitted to Department of Urology, Weifang Hospital of Traditional Chinese Medicine and Shanghai First People’s Hospital Affiliated to Shanghai Jiao Tong University from September 2008 to January 2012 were randomly divided into observation group (TURis-Bt preoperative intravesical instillation Epirubicin + conventional postoperative perfusion group) and control group (routine epirubicin intravesical instillation group after TURis-Bt) 35 cases. Before injection, 50mg epirubicin was dissolved in 50ml 5% dextrose injection. Preoperative bladder retention perfusion for 30 minutes was used to observe the tumor tissue and the surrounding bladder mucosa staining by cystoscopy. The bladder mucosal biopsies of epirubicin-orange were stained with TURis -Bt; control group 2cm away from the tumor and other parts of the bladder mucosa biopsy. The detection rate of the lesions such as carcinoma in situ (CIS), atypical hyperplasia and cystitis glandularis in both groups and the recurrence rate of the tumor after operation were compared between the two groups. Results: In the observation group, there were 56 orange-stained tumors in the para-tumor of the para-tumor, of which 7 were confirmed as carcinoma in situ, 5 were atypical hyperplasia, and 11 were cystitis glandularis. In the control group, , Atypical hyperplasia (3) and cystitis glandularis (2). The positive rates of the two groups of lesions were 41.1% (23/56) and 13.4% (17/127), respectively. The difference was statistically significant (P <0.01). The tumor recurrence rates in observation group and control group within two years after operation were 10.3% (4/39) and 35.3% (12/34) respectively, with statistical significance (P <0.05). Conclusion: TURIS-Bt preoperative intravesical instillation of epirubicin can increase the early detection rate of NMIUC lesions and reduce the recurrence rate of tumor.