论文部分内容阅读
膀胱内灌注BCG治疗表浅膀胱癌或预防术后复发效果良好,通常并发症很少,但作者报告了最近遇到5例BCG败血症,症状严重,经积极抢救,仍有3例死亡,其中1例并存器质性脑病,原已很衰弱,于第四次灌注BCG后10小时高热达40℃,经用雷米封等药物治疗,但很快死亡,另外2例有明显的BCG败血症,引起多器官功能衰竭而死亡,生存的2例发生同样的进行性败血症,用雷米封,利福平和链霉素未能控制,加用环丝氨酸三天病人才得以恢复,无后遗症。 5例中败血症发生于2～10次膀胱灌注BCG以后,3例有轻度BCG所致的膀胱炎,2例有严重的膀胱炎,3例灌注前有膀胱或尿道损伤,败血症症状发生于灌注后6～96小时,血培养及涂片检查均阴性,但1例尸体解剖时在肉芽肿中发现BCG。作者根据自己的经验指出下列几种情况容易引起
Intravesical instillation of BCG for superficial bladder cancer or prevention of postoperative recurrence is effective and usually has few complications, but the authors report that recently 5 patients had BCG sepsis with severe symptoms and 3 survived after active rescue Cases of organic encephalopathy, the original has been very weak, 10 days after the fourth infusion of BCG hyperthermia up to 40 ℃, with Remy the closure of other drugs, but soon died, and the other two cases had obvious BCG sepsis, causing Multiple organ failure and death, survival of 2 cases of the same progressive sepsis, with Remy sealed, rifampicin and streptomycin failed to control, plus cycloserine three days to recover, no sequelae. In 5 cases, sepsis occurred 2 to 10 times after intravesical instillation of BCG, 3 with mild BCG-induced cystitis, 2 with severe cystitis, 3 with bladder or urethral injury prior to perfusion and sepsis with symptoms of perfusion After 6 to 96 hours, blood cultures and smears were negative, but one case of BCG was found in the granuloma during autopsy. According to his own experience, the author points out the following situations are easy to cause