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目的探讨绿激光联合盐酸吡柔比星(THP)术前术后膀胱灌注对非肌层浸润性膀胱癌诊断与治疗的安全性及疗效。方法选取28例非肌层浸润性膀胱癌患者,将30mgTHP溶入30ml5%葡萄糖液中配成溶液。于术前15min将配好的溶液灌入已排空的膀胱中,保留10～15min。镜检辨认膀胱肿瘤及膀胱染色区域。对肿瘤组织及染色区域的膀胱粘膜取病理后即用绿激光汽化。术后即刻(24h内)将配好的THP溶液灌入已排空的膀胱中,保留30min后排出。术后每周灌注1次,连续8周。灌注8周后每月1次,连续8个月,并随访1～3年。结果 28例手术经过顺利,常规镜检未见异常膀胱粘膜区域灌注THP后呈深着色区76处,术后病理病变区域54处阳性率71%,尿路上皮癌与非典型性增生占阳性病变63%,非肌层浸润性膀胱癌检出率10.5%。28例患者均未见全身性药物不良反应。5例出现轻微膀胱刺激症状。复发4例,复发率为14.28%。结论术前膀胱灌注盐酸吡柔比星(THP)提高非肌层浸润性膀胱癌病变检出减少漏诊漏治。绿激光联合THP术前术后灌注对非肌层浸润性膀胱癌疗效确切,不良反应小,安全性好。
Objective To investigate the safety and efficacy of green laser combined with pirarubicin (THP) preoperative and postoperative bladder irrigation in the diagnosis and treatment of non-muscle invasive bladder cancer. Methods Twenty-eight non-muscle invasive bladder cancer patients were selected. 30 mg THP was dissolved in 30 ml 5% glucose solution to make a solution. 15min before surgery with a good solution into the bladder has been emptied, retained 10 ~ 15min. Microscopic examination of bladder tumor and bladder staining area. On the tumor tissue and stained area of the bladder mucosa after taking the path of the green laser vaporization. Immediately after surgery (24h) will be equipped with a good THP solution into the empty bladder has been emptied, leaving 30min after discharge. Perfusion after surgery once a week for 8 weeks. Perfusion 8 weeks after the monthly 1, for 8 months, and followed up for 1 to 3 years. Results Totally 28 cases underwent microscopic examination without any abnormal bladder mucosa perfusion with THP. There were 76 deep staining areas, with a positive rate of 71% in 54 postoperative pathological lesions, urothelial carcinoma and atypical hyperplasia 63%, non-muscle invasive bladder cancer detection rate of 10.5%. No systemic adverse drug reactions were seen in 28 patients. 5 cases showed mild symptoms of bladder irritation. Recurrent in 4 cases, the recurrence rate was 14.28%. Conclusions Preoperative intravesical instillation of pirarubicin hydrochloride (THP) improves the detection of non-muscle invasive bladder cancer and reduces the risk of missed diagnosis and treatment. Green laser combined with THP preoperative and postoperative perfusion on non-muscle invasive bladder cancer is effective, less adverse reactions, good safety.