目的 对比经尿道膀胱肿瘤电切联合全身化疗+膀胱内灌注与根治性膀胱切除术两种方法 治疗肌层浸润性膀胱癌的临床疗效及术后生活质量. 方法 回顾性分析 2012 年 1 月至2015 年9 月收治的56 例肌层浸润性尿路上皮癌(T2N0M0~T3N0M0期)患者的资料,将患者分为两组观察,36 例采用经尿道膀胱肿瘤电切联合吉西他滨、顺铂方案全身化疗及膀胱灌注保膀胱方案治疗,20 例采用根治性膀胱切除+标准淋巴结清扫+术后辅助性化疗方案治疗,分析两组患者围手术期的相关指标、远期治疗指标、生存时间、生命质量测定量表及膀胱癌生存质量测定特异模块量表评分. 结果 保膀胱组在手术时间、术中出血量、术中输血量、术后胃肠恢复时间、住院时间方面明显优于根治组(P＜0.05);在总并发症发生率与肠梗阻发生率方面低于根治组(P＜0.05 ).术后随访 3~57 个月,平均 29 个月,保膀胱组远期治疗指标优于根治组(P＜0.05).采用 Kaplan-Meier生存分析比较两组患者的生存率,差异无统计学意义(P＞0.05 ).两组术后生活质量评分,保膀胱组多领域优于根治组(P＜0.05). 结论 与根治性膀胱切除术相比,经尿道膀胱肿瘤电切+辅助化疗+局部膀胱内灌注方案治疗 T2N0M0~T3N0M0期肌层浸润性膀胱癌,术中出血少,围手术期恢复快、并发症少,远期治疗指标优,观察期内生存率相似,患者术后生活质量更好.%Objective To compare the clinical efficacy and postoperative quality of life between transurethral resection of the bladder tumor (TURBT)combined with systemic chemotherapy + in-travesical instillation and radical cystectomy (RC)in the treatment of muscle-invasive bladder cancer (MIBC). Methods A retrospective analysis of 56 patients with muscle-invasive urothelial carcino-ma (T2N0M0-T3N0M0)admitted between January 2012 and September 2015 was done.Patients were divided into two groups.Thirty-six cases underwent preservation of bladder therapy,TURBT+ gemcitabine,cisplatin regimen systemic chemotherapy + intravesical instillation chemotherapy, while 20 patients in the control group were treated with radical cystectomy + standard lymph node dissection + systemic chemotherapy.We observed and analyzed the perioperative related indicators, long-term treatment parameters,survival time,EORTC QLQ-C30 and QLQ-BLM30 scores of the two groups of patients. Results The duration of operation,intraoperative blood loss,amount of intraoperative blood transfusion,postoperative gastrointestinal recovery time and length of hospital stay in the bladder preservation group were significantly better than those in the RC group (P＜0.05).Com-parisons of perioperative complications,bladder preservation group of total complication and intesti-nal obstruction incidence were lower than those of RC group (P＜0.05).The patients were followed up for 3-57 months with an average of 29 months.The long-term treatment parameters were com-pared between the two groups.The incidence of bladder preservation group was lower than that of RC group (P＜0.05).Kaplan-Meier survival analysis was used to compare the survival rate of two groups of patients,which there was no statistical difference (P＞0.05).Two groups of EORTC QLQ-C30 and QLQ-BLM30 scores and other parameters of quality of life were compared,and bladder preservation group was superior to the RC group (P＜0.05). Conclusions Compared with RC,TURBT + GC adjuvant chemotherapy and local intravesical instillation regi-men in the treatment of T2N0M0-T3N0M0MIBC has the advantages of less bleeding,faster perioperative recovery,less perio-perative complications,better long-term treatment efficacy and better quality of life after surgery.However,survival rate of two groups were similar during the follow-up period.
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