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目的:探索最大限度TURBT+膀胱灌注化疗+髂内动脉栓塞化疗治疗肌层浸润性膀胱肿瘤的远期效果。方法:收集2003~2014年,福建省立医院收治确诊T2~3N0M0,但无上尿路梗阻的膀胱移行细胞癌患者。将行根治性全膀胱切除术的患者归积极组;将因各种原因改行姑息性治疗的患者归为保守组,姑息性治疗包括最大限度经尿道膀胱肿瘤电切、规律的表阿霉素膀胱灌注化疗,联合术后髂内动脉栓塞化疗。对比两组生存差异。结果:共入选患者90例,行根治性全膀胱切除术的患者66例,行姑息治疗的患者24例(26.7%)。中位随访时间50个月。生存分析结果显示,行根治性膀胱全术的积极组,中位无瘤生存时间为63个月(95%CI 40.3-85.6个月),中位总生存时间尚未到达;保守组的中位无瘤生存时间为21月(95%CI 6.7-35.3个月),中位总生存时间为54个月(95%CI 41.9-66.2个月);两组间对比,无瘤生存时间差异有统计学意义,63vs.21个月,P=0.002;中位总生存时间差异无统计学意义,NA vs.54个月,P=0.057。结论:最大限度TURBT+膀胱灌注化疗+髂内动脉栓塞化疗治疗肌层浸润性膀胱肿瘤尽管相比根治性治疗更容易复发或进展,但其远期疗效尚可,可以作为因各种原因不能接受根治手术患者保留膀胱的治疗方案之一。
Objective: To explore the long-term effect of TURBT + bladder irrigation chemotherapy and internal iliac artery embolization chemotherapy in the treatment of myometrial invasive bladder tumor. Methods: From 2003 to 2014, Fujian Provincial Hospital was admitted with T2 ~ 3N0M0, but no upper urinary tract obstruction bladder transitional cell carcinoma. Patients undergoing radical total cystectomy were included in the active group; patients who switched to palliative treatment for various reasons were classified as conservative and palliative treatment included maximal transurethral resection of the bladder tumor, regular epirubicin bladder Perfusion chemotherapy, combined with internal iliac artery embolization chemotherapy. Compare the two groups of survival differences. Results: A total of 90 enrolled patients, 66 patients undergoing radical cystectomy and 24 patients (26.7%) undergoing palliative treatment. The median follow-up time was 50 months. Survival analysis showed that in the active group, the median survival time was 63 months (95% CI 40.3-85.6 months) and the median overall survival time had not yet reached. In the conservative group, the median Tumor survival was 21 months (95% CI 6.7-35.3 months) with a median overall survival of 54 months (95% CI 41.9 to 66.2 months). There was a statistically significant difference in time to tumor-free survival between the two groups Significance, 63vs.21 months, P = 0.002; The median overall survival time was no significant difference, NA vs.54 months, P = 0.057. Conclusion: The maximum TURBT + intravesical chemotherapy + internal iliac artery embolization chemotherapy for the treatment of myometrial invasive bladder tumor is more likely to relapse or progress than radical treatment, but its long-term efficacy is acceptable, can be used as a result of various reasons can not accept the radical Surgical patients retain bladder one of the treatment options.