Pour into and treat bladder cancer How correct and effective it is

Pour into and treat bladder cancer How correct and effective it is
Pour into and treat bladder cancer How correct and effective it is
Bladder urine way epithelial cancer of the sincere feeling of medical center of urology surgery professor Li Ning, Wu Jieping of Peking University is the most common tumour of urology surgery, 70%~80% patient for the intersection of skin and layers of the intersection of bladder and cancer of soaking etc. at the first visit among them, basic treatment its to excise skill (TUR-BT) by urethral tumour . Though TUR-BT skill can be totally excised not to be one layer of bladder cancers soaked of skin in theory, but there is very high recurring rate in the clinical treatment, and some cases will develop into one layer of soaking bladder cancers of skin. So, TUR-BT postoperative complementary bladder poured into and treated and is widely used in clinic, the validity that it reduced tumour to recur has already been verified extensively. In recent years, with pour into further investigation that treat to bladder, relevant to treat idea to be day by day clear. It is first of all clear at first to recur dangerously, should define tumour recur with danger degree of progress. The intersection of skin and layers of recurring and progress with the intersection of tumour and number, the intersection of tumour and size, bladder of cancer of soaking etc. and recur number of times, tumour by stages and tumour grade, and it is closely related to store in factors such as normal position cancer,etc.. Among them the tumour number is right to recur on influence maximumly, the secondary influence factor is the recurring frequency of tumour, whether especially recur, grade at tumour size, tumour in postoperative 3 months. But the pathology of tumour is graded and tumour is in most close relations with tumour progress by stages. So, define the relevant factor and judge accurately it is not the danger that one layer of soaking bladder cancers recurs with progress of skin, have essential function on choice and therapeutic effect which pours into the scheme. The difference of risk and prognosis according to recuring, " the disease diagnosis of urology surgery of Chinese treats the guide " not to one layer of soaking bladder cancers of skin divide into the following three groups: First, low is endangered: For the first time hair, single shot, Ta, G1 ' Urine way epithelial cancer of the low rank) (Note: Must it possesses the above-mentioned conditions to be low to it endangers to be one layer of soaking bladder cancers of skin at the same time) . Second, endanger high: Any T1, G3 ( High-level urine way epithelial cancer) , Tis. Third, middle is endangered: Except that the above two kinds of other situations, include Ta, G1 (urine way epithelial cancer of low rank) that occurs frequently, recurs . European bladder cancer diagnose treat guide, use the intersection of EORTC and tumour of grade form grade, according to different to recur with progress grading, judging recurring and the intersection of progress and probability of patient, and it is basic, normal, high to carry on the dangerous one and endanger to divide into groups. This method is more meticulous to the dangerous prediction of degree of cancer prognosis of bladder, but relatively complicated too. Nowadays the criteria for classification of every guide has some the difference in the world, but the basic principle is unanimous, have offered the foundation for the fact that it is not choice of one floor of soaking therapeutic method of tumour of the skin. Bladder punch postpone, pour into at present, the bladder pours into chemotherapy at once in the postoperative 24 hours such as TUR-BT, do not become that the skin layer soaks cancer patient's postoperative standard scheme poured into of the bladder, recommended by every clinical guide of making a diagnosis and giving treatment. The intersection of chemotherapy and medicine that finish pour into, treat, known as postoperative the bladder pours into chemotherapy at once in the postoperative 24 hour such as TUR-BT. The research has suggested postoperative TUR-BT bladder pour into chemotherapy to single shot and occur frequently bladder cancer effective at once, as to low to endanger person who didn't get one layer of soaking bladder cancers of skin, pour into after the chemotherapy at once while being postoperative, probability that tumour recur very low, need, continue, go on follow-up pour into and treat, it is postoperative single time that pours into chemotherapy at once. In consideration of security, chemotherapy medicine pour into, have bladder punch in the skill TUR-BT and postoperative obvious patient of hematuria unsuitable to adopt. When the bladder punch appears or is close to punch in TUR coursing, the bladder may cause medicines to let out outside the bladder while pouring into the chemotherapy medicine, and may initiate the serious complication. So, in order to prevent the occurrence of this kind of complication, while the obvious bladder wall punch or suspected to punch to appear, should prevent the bladder at once after the operation from pouring into chemotherapy. It pour into follow-up important likewise to in skin layers of soaking bladder cancer in endangering and a high to endanger one, it is not enough to obtain most satisfied reducing the result of recuring that the bladder pours into chemotherapy at once in postoperative 24 hours, need to continue pouring into and treating the subsequent bladder, once every week, amounts to 4~8 weeks. Carry on the bladder and keep pouring into chemotherapy subsequently, once every month, totally 6~12 months. The bladder of our country pours into the daily medicine of chemotherapy including table gently more gentle than star, mitomycin, pyrrole and moulder and plainer than star, A, hydroxyl likes alkali of trees etc.. The pH value of the urine, density of chemotherapy medicine relate to the fact that the bladder pours into and melts the curative effect fruit, and the medicine is more important than medicine amount in density. Pour into the result and is superior to a short time to pour into in the long-term bladder. The big sample is prospective studies to show, the bladder can be lengthened and had one among the one that recur while pouring into chemotherapy, it is definite to reduce the result that tumour recurs, has but not demonstrated obvious function to the progress of soaking tumour on TaTi stage bladder cancer. In addition, Bacillus Calmette-Guerin (BCG) to pay attention to the side effect with Bacillus Calmette-Guerin Bladder pour into lie between, lead, achieve therapeutic effect is high to it endangers to be one layer of soaking bladder cancer TUR-BT postoperative prevention of recuring of skin can prevent effectively, through immunoreaction, and may prevent the progress of tumour. At present, BCG bladder pour into cancer regard as best to treat, choose the intersection of guide and extensive recommendation already to the intersection of bladder and the intersection of normal position and cancer and high-level to soak bladder the intersection of skin and layer, it is generally acknowledged its curative effect is superior to various chemotherapy medicines. But to one layer of soaking bladder urine way epithelial cancer of skin, seldom propose the conduct BCG is poured into and treated. As to in endanger it is skin layer soaking bladder urine way epithelial cancer but speech,there are to prevent tumour from recuring on purposes main that bladder pour into, the general recommendation adopts the bladder to pour into chemotherapy, can adopt BCG to pour into and treat too. BCG treatment adopts for 6 weeks and pours into to induce the immunity to reply, adds the pouring into and is strengthened of 3 weeks, in order to maintain good immunoreaction. Adopt the standard dose generally ' 81~150mg) . BCG need, keep, pour into 1~3 ' Keep pouring into for one year at least) ,Propose repeating BCG to pour into during 3, 6, 12, 18, 24, 36 months, in order to keep and strengthen curative effect. It is that the bladder stimulates symptom that the bladder pours into the main side effect treated, the intensity is correlated with with pouring into the dosage and frequency. TUR-BT postoperative bladder at once pours into the side effect that should pay attention to the medicine even more. The side reaction that general BCG pours into should be poured into obviously more than the chemotherapy medicine, besides some symptom, can also present side reaction such as influenza one kind of symptoms and rare tuberculosis and septicaemia, prostatitis, epididymis inflammation of whole body. So, when TUR-BT postoperative bladder has situations such as open wound surface or having hematuria of naked eye,etc., can't pour into BCG bladder. Most side effects can be improved by oneself after stopping pouring into, when present the serious bladder while pouring into to stimulate symptom, should delay or stop pouring into and treating, so as not to continue more serious responses such as the contracture of hair bladder,etc..


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