动脉化疗配合手术治疗膀胱癌的效果

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1、维普资讯http://www.cqvip.com中华泌尿外科杂志2003年7月第24卷第7期ChinJUrol，July2003，Vo1．24，No．7·451··论著·动脉化疗配合手术治疗膀胱癌的效果赵丕显陈辉赵玉兰耿敬株王小民李长福徐万海乔忠杰【摘要】目的评价动脉灌注化疗配合膀胱部分切除治疗膀胱癌的临床效果。方法膀胱癌患者l7l例，均行膀胱部分切除，随机分2组：(1)术前动脉灌注化疗组78例，行化疗前后进行膀胱镜观察；58例术后行病理形态学观察；12例术后行电镜超微结构观察；35例采用流式细胞术(FCM)行肿瘤细胞核DNA含量测

2、定。(2)术后动脉灌注化疗组93例。膀胱癌单纯手术者35例，测定DNA含量作为对照。所有病例随访5年。结果术前灌注化疗78例膀胱镜检查者，肿瘤消失9例，肿瘤缩小≥50％49例，有效率74．3％(58／78)。58例病理形态学观察，有效率75．9％(44／58)。12例电镜观察见肿瘤细胞明显受损。DNA含量测定，通过DNA指数(DI)、增殖指数(PI)、S期比率(SFR)、异倍体率4项指标的测定进行对比，在Ⅱ、Ⅲ级膀胱癌中，行动脉化疗与否，差异有显著性意义(P<0．05)。171例经动脉灌注化疗配合手术的病例5年生存率84．2％(14

3、4Z171)，复发率9．3％(16／171)。结论动脉灌注化疗对膀胱癌有明显降级、降期、缩小病灶的作用，可降低复发率，提高生存率。【关键词】膀胱肿瘤；动脉灌注化疗；外科手术ClinicalEffectofarterialchemotherapyandoperationforbladdercarcinomaZHAOPei—xian，CHENHui，ZHAOYu—lan，eta1．Departm,entofUrology，ThirdAffiliatedHospitalofHarbinMedicalUniversity，Harbin150

4、040，China【Abstract】ObjectiveToevaluatetheclinicaleficacyofarterialchemotherapyandpartialcystoto—myfortreatmentofbladdercarcinoma．MethodsAtotalof171casesofthebladdercarcinomawhowouldundergopartialcystotomywererandomlydiviedeinto2groups：(1)78patientsreceivedarterialchemo

5、therapybeforetheoperation；(2)93casesweretreatedwitharterialchemotherapyaftertheoperationInaddition，35caseswhounderwentoperationalonewereselectedfortheDNAcontentdetectionbyFCMascontrolgroup．Allthesecaseswerefollowedupfor5years．ResultsAmongthe78caseswiththecystoscopy，the

6、tumorsdisappearedin9casesandthetumorsshrankbyhalformorein49cases．Thetotaleffectiveratewas74．3％(58／78J．ThepathologicalexaminationshowedtheeffectiverateWaS75．9％(44／58)．Therewasaremarka—blechangeinthecarcinomacellsbytheelectronicmicroscopy．DNAindex，proliferationindex，SFRa

7、ndane—uploidrateweredetectedbyFCM．InthecasesofgradesⅡandⅢbladdercarcinomathereWaSastatistical—lysignificantdifference(P<0．05)betweenthosewithandthosewithoutarterialchemotherapy．The5-yearsurvivalratewas84．2％(144／171)forthepatientswhoreceivedarterialchemotherapycombinedw

8、ithoper—ation．ConclusionsThearterialchemotherapyWaSquiteeffectivefordegradingandsubduingthebladdercarcinomaandimprovi