| Background and Objective:Bladder cancer(BC)is one of the most common urological Malignant neoplasms in China.Male incidence rate is 3 or 4 times to the female,The incidence of BC ranked ninth of the malignant tumor in the global,the death rate of BC is the second in the global male genitourinary system tumors.According to the different stages of tumor,treatment and prognosis,bladder cancer can be divided into non-muscle invasive bladder cancer(NMIBC)and muscle invasive of bladder cancer(MIBC).And in the initial tumor,NMIBC accounted for 70%-80%.Transurethral resection of bladder tumor(TURBT)is the preferred treatment.However,high recurrence rate after TURBT make the patient needs to undergo regular cystoscopy and long-term bladder perfusion chemotherapy,life quality drops greatly at the same time also increased the economic burden of patients,so how to reduce NMIBC tumor recurrence after surgery is the urgent problem in bladder cancer treatment.The cause of the recurrence of bladder cancer is complex,basic research has found that residual cancer cells and its implantation are important reasons for the recurrence of NMIBC.Therefore,the removal of residual tumor cell after transurethral resection is of great significance to prevent recurrence of NMIBC.Studies have shown that when intravesical instillation chemotherapy be carried out after TURBT have different effects on treatment of tumor recurrence.The earlier intravesical instillation chemotherapy executed the better effect of bladder perfusion chemotherapy to prevent recurrence of bladder cancer.Mainly because the early intravesical chemotherapy can be more effective on killing postoperative residual tumor cells.with the research on the mechanism of the recurrence of bladder cancer development.Urology surgeon have pay more attention on the time carring out intravesical instillation chemotherapy after TURBT.Immediate intravesical chemotherapy have been respected by domestic and foreign experts because of its ability to more effectively kill the residual tumor cells.According to the different levels of chemotherapy temperature of intravesical instillation of chemotherapy,it is divided into normal temperature intravesical chemotherapy and hyperthermic intravesical chemotherapy(HIVEC).Compared with normal temperature perfusion chemotherapy,HIVEC can significantly reduce the recurrence rate of NMIBC,prolong the survival time of patients.However,taking into account the TURBT postoperative bleeding,perforation and other complications,so HIVEC perfusion time is generally 3-7 days after surgery.The relevant reports of immediately HIVEC after TURBT is rare,This study is to investigate the safety and the effect on the bladder cancer recurrence rate of gemcitabine immediately visible hyperthermic intravesical chemotherapy with the BR-TRG-I type body heat perfusion therapy instrument after transurethral resection of bladder tumor.Methods:Retrospectiveiy analyze the 84 cases of patients with NMIBC from August 2015 to February 2016 at the The People's Hospital of Zhengzhou University.According to the different methods of intravesical chemotherapy,patients were divided into immediate HIVEC group(n=44)and control group(n=40).The patients in the control group were treated with gemcitabine intravesical chemotherapy immediately after transurethral resection of bladder tumor.The immediate HIVEC group were treated gemcitabine immediate hyperthermic intravesical chemotherapy with BR-TRG-I type infusion therapy instrument after transurethral resection of bladder tumor.Then both the two groups were continued given gemcitabine intravesical chemotherapy for one year.To compare the postoperative complication rates,chemotherapy adverse reactions,and the recurrence rates after 6 months and 12 months.Results:There was no significant difference in gender,age,BMI,concomitant disease,Bladder tumor related indicators between immediate HIVEC group and control group.In experimental group(P>0.05),There was no significant difference in resection of bladder tumor resection time,time of postoperative bladder washing,postoperative time placing a urinary catheter,the total cost of treatment between immediate HIVEC group and control group(P>0.05).In the immediate HIVEC group,the main adverse reactions are hematuria(25.0%),frequent urination(20.5%),urodynia(18.2%),fever(5.9%)and gastrointestinal reactions(11.8%),that was 37.5%,27.5%,22.5%,7.5% and 10.0% in the control group respectively,There was no significant difference in the incidence of complication between the two groups(P>0.05).The recurrence rate after 6 months was 11.4% in the immediate HIVEC group and 22.5% in the control group,There was no significant difference in the incidence of complication between the two groups(P>0.05).The 12 months recurrence rate in the observation group is 18.1%,significantly lower than the recurrence rate of the control group,the difference was statistically significant(P<0.05).Immediate HIVEC group relapse-free survival time was(14.30±0.58)months,the control group(13.70±0.92)months,Immediate HIVEC group compared with control group relapse-free survival time prolonged,difference was statistically significant(P < 0.05).Conclusion:1.Gemcitabine Immediate hyperthermic intravesical chemotherapy with the BR-TRG-I type body heat perfusion therapy instrument after transurethral resection of bladder tumor is feasible,The incidence of gemcitabine immediate hyperthermic infusion was similar to that of intraventricular infusion chemotherapy at room temperature without increasing the incidence of adverse events,Preservation of resection in the bladder can ensure that the immediate bladder perfusion chemotherapy is safer.2.Immediate hyperthermic intravesical chemotherapy compared with normal temperature instantly ntravesical chemotherapy can reduce NMIBC short-term postoperative recurrence rate.extend the recent relapse-free survival time.However,further randomized controlled trials and large case studies are needed to further confirm the long-term effects of relapse prevention. |
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