黄　骥　涂新华　郝　超

江西省肿瘤医院泌尿外科，江西南昌330029

新辅助化疗并术中125I植入治疗Ⅲ期膀胱癌的临床分析

黄骥涂新华郝超

江西省肿瘤医院泌尿外科，江西南昌330029

目的探讨新辅助化疗并术中125I植入治疗Ⅲ期膀胱癌的短期疗效与安全性。方法42例初治Ⅲ期膀胱癌患者随机分为研究组（19例）和对照组（23例），研究组患者接受GC方案静脉化疗1个周期，15 d后进行根治性膀胱切除术，并对残余及可疑病灶植入放射性125I粒子，对照组的23例患者仅接受1个周期GC方案静脉化疗及根治性膀胱切除术治疗。结果随访期内（6～12个月）两组均无患者死亡。研究组无患者出现局部复发，肿瘤复发率0%（0/19），无远处转移患者（0/19）；对照组6例出现局部复发，肿瘤复发率26.0%（6/23），远处转移率8.7%（2/23），差异有统计学意义（均P＜0.05）。两组不良事件的发生率相当（P＞0.05）。结论新辅助化疗并术中125I植入治疗Ⅲ期膀胱癌是一种安全、有效的治疗方式，具有良好的短期疗效。

膀胱肿瘤曰125I粒子曰安全性曰毒性

［Abstract］Objective To investigate the short-term effect and safety of neoadjuvant chemotherapy combined with intraoperative125I implantation in the treatment of bladder cancer of stageⅢ.Methods A total of 42 initially treated patients with bladder cancer of stageⅢwere randomly divided into study group（19 cases）and control group（23 cases）. Intravenous chemotherapy with GC scheme for 1 period was given to the patients of study group and radical cystectomy was performed after 15 days and125I particles were implanted into the residual and suspected lesions.Intravenous chemotherapy with GC scheme for 1 period and radical cystectomy was given to the 23 patients of control group.Results No death of the patients was presented during the follow-up period（6-12 months）.The rate of local recurrence and tumor recurrence of the patients form study group was 0%（0/19）and no distant metastasis（0/19）；while local recurrence and tumor recurrence were presented in 6 patients of the control group with the rate of 26.0%（6/23）and the distant metastatic rate was 8.7%（2/23）.The differences was statistically significant（both P＜0.05）.The incidence rate of adverse events of both group was similar（P＞0.05）.Conclusion Neoadjuvant chemotherapy combined with intraoperative125I implantation is a safe and effective way of treating bladder cancer of stageⅢ，with good short-term effects.

［Key words］Bladder cancer；125I particle；Safety；Toxicity

膀胱癌是我国泌尿外科最常见的恶性肿瘤之一，在世界范围内，其发病率高居男性恶性肿瘤第四位［1］。Ⅲ期膀胱癌手术难度大、风险高，加之术后易出现复发转移，预后不佳。研究表明［2］，铂类为基础的新辅助联合化疗后行根治性膀胱切除术可降低局部复发率，延长中位生存期。然而仅有少数患者可耐受3～4个周期静脉化疗毒副反应，且术前长程化疗可能会延误手术实施，因此探索新的治疗方案十分关键。近年来，125I粒子植入治疗已在前列腺癌、肺癌、肝癌、胰腺癌、头颈部癌等肿瘤中取得确切疗效，但应用于膀胱癌的报道甚少。……