【摘要】 目的探讨膀胱内灌注纤维蛋白溶解抑制药物增强卡介苗(BCG)预防膀胱癌术后复发的疗效。方法将208例浅表性膀胱移行细胞癌(BTCC)患者术后随机分成5组,A组44例,定期膀胱内灌注BCG 100~120 mg+氨甲苯酸(PAMBA)0.1 g+生理盐水,B组41例,灌注BCG 50~60mg+PAMBA 0.1 g+生理盐水,C组41例,灌注BCG 100~120 mg+氨基己酸(EACA)2.0 g+生理盐水,D组39例,灌注BCG 50~60 mg+EACA 2.0 g+生理盐水,E组43例,灌注BCG 100~120 mg+生理盐水。每周1次,6次后每月1次。灌注后每3个月作膀胱镜检查,必要时取活检明确肿瘤有无复发。结果随访4~58个月,平均22个月,A~E组BTCC复发率分别为10.3%、8.6%、9.7%、9.7%和29.7%。A、B、C、D各组抗BTCC复发的疗效均明显优于E组(对照组),差异有统计学意义(P<0.05);B、D组预防BTCC术后复发的效果与A、C组比较差异无统计学意义。结论膀胱内灌注纤维蛋白溶解抑制药物PAMBA、EACA可增强BCG预防膀胱癌术后复发的疗效,BCG剂量减半后,疗效不降低。更多还原

【Abstract】 Objective To study the effect of intravesical instillation of antifibrinolytic agents with bacillus Calmette-Guerin(BCG) in preventing recurrence of superficial bladder transitional cell carcinoma(BTCC) after surgical management.Methods A total of 208 cases of superficial BTCC who underwent transurethral resection of bladder tumor(TURBt) or partial cystectomy were divided into 5 groups.Then different doses of BCG with or without antifibrinolytic agents plus NS were regularly instilled into bladders(once a week,6 weeks later once a month).Group A(44 cases) received intravesical instillation of 100-120 mg BCG plus 100mg para-aminomethyl benzoic acid(PAMBA);group B(41 cases),instillation of(50-)60 mg BCG plus 100 mg PAMBA;group C(41 cases),100-120 mg BCG plus 2.0 g epsilon-aminocarproic acid(EACA);group D(39 cases),50-60 mg BCG plus 2.0 g EACA;and group E(controls,43 cases),100-120 mg BCG.Cystoscopy was performed every 3 months and side effects were monitored.All the cases were followed up for 4 to 58 months(mean,22.5 months). Results The rates of tumor recurrence of groups A,B,C and D(BCG plus antifibrinolytic agents intravesical instillation) were 10.26%,(8.57%),9.68% and 9.68%,respectively,which were significantly lower than that of group E(BCG instillation alone,29.73%)(P<0.05).And there was no significant difference of tumor recurrence rate between group A and group B or between group C and group D(groups A and C,with high dose of BCG;groups B and D,with low dose of BCG)(P>0.05).But the side effects occurred less frequently in groups B and D after BCG instillation than in groups A and C.Conclusions The efficacy of BCG in preventing recurrence of superficial BTCC can be enhanced by intravesical instillation of antifibrinolytic agents.Besides,BCG can be used at low dose with satisfactory effects.更多还原