First, the basic treatment plan

The biological characteristics of bladder cancer are very different, and there are many treatments, but the treatment principle is still surgical treatment, and radiotherapy, chemotherapy, immunotherapy and biotherapy play an auxiliary role. Choose different treatment methods according to different clinical analysis.

Stage ⅰ and ⅱ: Transurethral resection or electrocautery or partial cystectomy plus postoperative bladder perfusion chemotherapy.

Stage Ⅲ: Selective partial cystectomy (T3a)+ adjuvant chemotherapy; Total cystectomy or radical total cystectomy plus preoperative radiotherapy or adjuvant radiotherapy/chemotherapy.

Stage ⅳ: radiotherapy and chemotherapy.

Cystoscope was reviewed every 3 months within 2 years after operation, and every 6 months after 2 years 1 time. If there is a recurrence, treat it in time. Postoperative bladder perfusion is generally 1-2 years.

Traditional Chinese medicine treatment according to the pathogenesis of tumor should run through the whole treatment process.

Second, Chinese medicine treatment

Bladder cancer is characterized by deficiency in substance and solid in substance. It belongs to kidney-qi deficiency, spleen-qi deficiency, lung-qi deficiency and liver-qi stagnation. Symptoms are damp-heat, toxic heat, turbid phlegm and blood stasis. Among them, the principle of drug treatment should be based on tonifying kidney, invigorating spleen and benefiting lung, and at the same time, taking into account diuresis and hemostasis, clearing heat and hemostasis, detoxification and removing blood stasis. At the same time, the application of traditional Chinese medicine can reduce the side effects of chemotherapy and improve patients' tolerance to chemotherapy. And the effect is obviously better than that of patients with simple chemotherapy. However, due to some objective reasons, the treatment of bladder tumor in traditional Chinese medicine is mostly limited to middle and late cases, and the mortality rate is still high. Therefore, it is still necessary to carry out multi-directional prospective clinical research, further explore, sort out and screen prescriptions with definite anti-cancer effect, formulate reasonable treatment plans and adopt comprehensive treatment methods to improve the clinical survival rate.

(A) treatment based on syndrome differentiation

1. Kidney-qi deficiency type

Symptoms: dysuria, salivation, weak urination, lumbago, pale tongue, thin and white fur and thready pulse.

Treatment: Bushen Yiqi.

Prescription: Shenge powder. 60g of Folium Pyrrosiae, Herba Dianthi, Folium Bambusae, Coicis Semen, 30g of Polyporus and Semen Vaccariae, 65438 00g of gecko and ginseng (decocted in water), 25g of Radix Astragali, 65438 02g of ootheca Mantidis, Poria and Angelica sinensis.

2. Weak temper type

Symptoms: urine can not be discharged, or the amount is small but unpleasant, hematuria, weakness of limbs, muscle wasting, thin stool, loss of appetite, shortness of breath and so on. Pale tongue with white fur and deep and weak pulse.

Treatment: invigorating spleen and qi, dredging waterways.

Prescription: Buzhong Yiqi Decoction. 60g of Folium Pyrrosiae, Herba Dianthi, Folium Bambusae and Coicis Semen each, 30g of Polyporus and Vaccariae Semen each, 25g of Radix Ginseng10g (decoction), 25g of Radix Astragali, 60g of Atractylodis Macrocephalae, Radix Angelicae Sinensis, Pericarpium Citri Tangerinae, Cimicifuga Cimicifuga, Radix Bupleuri10g, and 6g of Radix Glycyrrhizae.

3. Deficiency of both spleen and kidney

Symptoms: low back pain, abdominal distension, abdominal distension, hematuria, anorexia, vomiting and nausea, pain relief, pale face, fatigue and shortness of breath, pale tongue, thin and white fur, deep and thin pulse, weakness or weakness.

Treatment: invigorating spleen and kidney, softening and resolving hard mass.

Prescription: Siwu decoction combined with Zuogui drink. 60g of Folium Pyrrosiae, Herba Dianthi, Folium Bambusae and Coicis Semen, 30g of Polyporus and Semen Vaccariae, 0/0g of Ginseng/kloc-0 (decoction), 0/0g of Radix Astragali, Fructus Psoraleae and Eucommiae Cortex, 0/2g of Atractylodis Macrocephalae12g of Rhizoma Polygonati and Fructus Lycii, and 6g of Glycyrrhiza uralensis.

4. Liver depression and qi stagnation type

Symptoms: emotional depression, dysphoria, dysuria, hematuria, lumbago, abdominal distension and abdominal pain, thin yellow fur, red tongue and thready pulse.

Treatment: soothing the liver and regulating qi, diuresis.

Prescription: Chen Xiangfen. 60g of folium Pyrrosiae, Herba Dianthi, Folium Bambusae, Coicis Semen, 30g of Polyporus, Semen Vaccariae, 65438 00g of Aquilaria Resinatum, 65438 02g of Angelica sinensis, 65438 02g of Malva, and 25g of talc. If qi is depressed, Radix Gentianae and Fructus Gardeniae can be added to clear the depressed fire.

5. Hot and humid betting type

Symptoms: no urination, or short and red urine, fever, urgency, frequent urination, dysuria, hematuria, slight abdominal distension, backache, edema of lower limbs, bitter and sticky mouth, or thirst, yellow and greasy tongue coating, and slippery or thin pulse.

Treatment: clearing away heat and promoting diuresis, removing blood stasis and relieving pain.

Prescription: Bazheng Powder. 60g of Folium Pyrrosiae, Herba Dianthi, Folium Bambusae, Coicis Semen, 30g of Polyporus, Semen Vaccariae, Herba Cirsii, Lalang Grass Rhizome, 65438 02g of Cortex Moutan, 65438 00g of Olibanum, 65438 00g of Myrrha, Pollen Typhae, 65438 05g of Radix Paeoniae Rubra and Rhizoma Corydalis.

6. Syndrome of lung heat

Symptoms: dysuria, hematuria, fever, cough, dry throat pain, shortness of breath, thirst, thin yellow fur and rapid pulse.

Treatment: clearing lung heat and dredging waterways.

Prescription: Qingfei Decoction. 60g of folium pyrrosiae, herba Dianthi, folium Bambusae, Coicis Semen, 30g of Polyporus and Semen Vaccariae, 0/0g of Scutellariae Radix, Cortex Mori, Radix Ophiopogonis, Plantaginis Semen, Poria, Akebia Akebia, and Gardenia/kloc. If the heart fire is strong and the tip of the tongue is red, Coptidis Rhizoma can be added to clear the heart, and symptoms such as nasal congestion, headache and floating pulse can be added to relieve exterior symptoms and spread the lung.

7. Blood stasis internal resistance type

Symptoms: dull complexion, pain in waist and abdomen, mass in waist and abdomen, abdominal distension in kidney area, dark purple tongue or petechiae, thin yellow fur, unsmooth pulse or knotting.

Treatment: promoting blood circulation, removing blood stasis, regulating qi and dispersing stagnation.

Prescription: Taohong Siwu Decoction. 60g of Folium Pyrrosiae, Herba Dianthi, Folium Bambusae, Coicis Semen, 30g of Polyporus, Semen Vaccariae, Radix Salviae Miltiorrhizae, 0/0g of peach kernel, safflower, Ligusticum Chuanxiong, Rhizoma Corydalis, Rhizoma Cyperi, Fructus Aurantii/kloc, and 0/5g of Radix Paeoniae Rubra/kloc. fresh

8. Yin deficiency and internal heat type

Symptoms: dry mouth, aversion to drinking, fever, short and red urine, dry stool, lumbosacral pain, low fever, emaciation, red tongue, thin coating and rapid pulse.

Treatment: nourishing yin and clearing heat, promoting blood circulation and removing blood stasis.

Prescription: white yellow soup. 60g of Folium Pyrrosiae, Herba Dianthi, Folium Bambusae and Coicis Semen, 30g of Polyporus, Semen Vaccariae and Radix Salviae Miltiorrhizae, 0/0g of Rhizoma Anemarrhenae, Cortex Phellodendri, Rhizoma Dioscoreae, Rhizoma Alismatis, Cortex Moutan, Poria and Radix Rehmanniae, 0/0g of Radix Paeoniae Rubra15g of Radix Paeoniae Rubra and 0/2g of Herba Lycopi.

For the side effects caused by radiotherapy and chemotherapy, the prevention and treatment of traditional Chinese medicine can be found in the fourth quarter of Chapter VII.

(2) Prescriptions and prescriptions

1. Herba et Gemma Agrimoniae, Commelina communis 30g each, Eupatorium odoratum 60g, Herba Hyperici Japonici 45g, Herba Plantaginis and Caulis Polygoni Multiflori 20g each. Decoct with water instead of tea. If you feel abdominal distension and discomfort after taking it, you can add Sijunzi decoction and decoct it together. It is suitable for bladder bleeding or complicated infection. 1 Effective and can be repeated for 3 weeks.

2. Lysimachia christinae 30- 120g, decoction instead of tea. It is suitable for bladder cancer patients with poor urine drip.

3. 30g of Hedyotis diffusa, 30g of Lysimachia christinae and 30g of Smilax glabra, 65438+/-00g of Herba Dianthi and Polygonum aviculare, 5g of Radix Glycyrrhizae and 5g of Akebia Akebia; Plantago asiatica and Alisma orientalis each 65438 00 g; Used for dysuria; Thistle charcoal and rehmannia glutinosa increased hematuria by 65438±05g respectively. Decoct with water, daily 1 dose. Suitable for patients with bladder cancer pain, hematuria or dysuria.

4. 5 grams of Rhizoma Sparganii, Rhizoma Curcumae, Pericarpium Citri Reticulatae Viride, Herba Agastaches, Rhizoma Cyperi and Glycyrrhrizae Radix, 3 pieces of ginger and 2 pieces of jujube, decocted in water. 1 daily 1 dose, take it frequently. Suitable for all types of bladder cancer. If urination is unfavorable, add Polygonum Aviculare 65438±00g, Coicis Semen 65438±05g, Herba Lysimachiae 30g and Herba Plantaginis 30g; Poria cocos 10g and Lygodium japonicum 5g are added for painful urination; Urinary retention increased, thistle root, coix seed and corn stigma were 30 each.

5. Radix Pseudostellariae, Poria, Atractylodis Macrocephalae each 65438±05g, Radix Glycyrrhizae Preparata, Herba Hedyotidis Diffusae each 65438±00g, Folium Bambusae, Coicis Semen 30g, Cortex Phellodendri 30g, Liuwei Dihuang Pill (sword) 30g, decocted with water, with 65438 0 doses per day. It is suitable for patients with transitional epithelial papillary carcinoma of bladder and recurrence after surgical resection.

6. Solanum nigrum, Solanum lyratum Thunb, Rhizoma Smilacis Glabrae and Herba Hedyotidis Diffusae each 30, Herba Hedyotidis Diffusae 15, Lygodium japonicum, Juncus Juncus and Radix Clematidis each 10. Decoct with water, daily 1 dose. It is suitable for papillary carcinoma, transitional cell carcinoma and squamous cell carcinoma of bladder.

7. Codonopsis pilosula 15g, Radix Astragali, Poria, Fructus Ligustri Lucidi, Herba Taxilli and Herba Hedyotidis Diffusae each 30g, daily 1 dose, decocted in water. It is suitable for patients with papillary carcinoma of bladder, poor constitution and insufficient vital qi.

8. Mylabris, rhubarb, ginseng, polyporus. Radix et Rhizoma Rhei, Radix Ginseng, Polyporus and Poria powder are added into Mylabris wine immersion liquid, and mixed with egg white to make mung bean pills. Five capsules each time and three times a day. It is suitable for papillary carcinoma, adenocarcinoma, invasive carcinoma and non-epithelial tumor of bladder. Combined with different stages of illness and the principle of syndrome differentiation, it is suitable for Hedyotis diffusa, Sophora Tonkinensis, Prunella vulgaris, Smilax glabra, Scutellaria barbata, Radix Astragali, Salvia Miltiorrhiza, Cortex Phellodendri, Cortex Acanthopanacis, Radix Angelicae Sinensis, etc. Decoct with water, 65438 0 dose per day, and take it twice.

9. Radix Clematidis, Poria, Semen Vaccariae, Herba Cirsii, Radix Rubiae and Herba Patriniae each 30g, beet 60g, Radix Paeoniae Rubra, Rhizoma Corydalis and Squama Manis each 65438 05g, decocted in water. Daily 1 dose, taken twice. It is suitable for patients with urinary incontinence and dysuria caused by bladder cancer compression.

(3) Acupuncture therapy

1. The main acupoints are Guanyuan Shu, Bladder Shu, Shenshu, Chengfu, Sanyinjiao, Yinlingquan, and Neiguan and Yifeng. Take kidney, adrenal gland, endocrine, heart, liver, etc. Starting from the auricular point, and giving the alternate diarrhea, once a day/kloc-0, and keeping the needle for 20 ~ 30 min each time. Suitable for all stages of bladder cancer.

Acupuncture and acupoint injection are used to relieve pain. Take Guanyuan, Sanyinjiao, Shenjiao and Shenshu points and inject 0.5% ~ 1% procaine 0.5 ~ 1 ml into Shenshu points on both sides respectively. Injection once every two days, continuous 10 ~ 15 times. Procaine skin test should be done before injection. It is suitable for patients with low back pain and abdominal pain of bladder cancer.

3. Electro-acupuncture Stimulation An electro-acupuncture therapeutic apparatus is used, in which the electrode plate is connected to the pain and the negative electrode is placed on the opposite side of the pain, so as to perform medium and low frequency stimulation. It is suitable for patients with bladder tumor pain.

(4) Massage therapy

Take Shenshu, Guanyuan, Sanyinjiao, Dazhui, Quchi, Hegu and other acupoints, and use methods such as rubbing, holding, rubbing, shaking and patting to strengthen the body resistance and eliminate evil, invigorate the kidney and strengthen the spleen. It is suitable for patients with bladder cancer, lumbago, urinary retention and systemic swelling and pain.

(5) External drugs

1. Fresh Lysimachia christinae is not limited. Wash it with clear water, add a little salt, mash it, and apply it to the corresponding parts of swelling and pain, slightly thicker than cents, and change it once a day. Those with blisters, burning pain and ulceration can be disinfected and take antibiotics to prevent infection. This method can relieve cancer pain, and it is simple and suitable for cancer patients at the grass-roots level or at home.

2. Aitong powder contains 20g of Kaempferia Kaempferia, Olibanum, Myrrha, Curcuma Rhizome, Gardenia, Radix Angelicae Dahuricae and Scutellariae Radix, 0g of Foeniculum vulgare, Flos Caryophylli, Radix Paeoniae Rubra, Radix Aucklandiae and Cortex Phellodendri, and 20g of castor seeds. Grind the medicine into fine powder and apply it to the pain of tumor with egg white. Replace it every 6 hours. Suitable for patients with bladder cancer and low back pain.

(6) Diet aftercare

1. The postoperative diet after bladder cancer surgery should be based on spleen and kidney qi deficiency. Astragalus membranaceus 30g and japonica rice 50g were selected. First, boil Astragalus membranaceus with water to get juice to remove residue, then cook rice porridge with juice and eat it on an empty stomach in the morning. Has the effects of invigorating qi, invigorating spleen, and promoting blood production and absorbing blood. Or use 50g of lotus seed meat, 30g of longan meat, and appropriate amount of rock sugar to make a paste, add a small amount of rice to cook porridge, and eat a small bowl before going to bed every night. Nourish the heart and kidney, soothe the nerves and stop bleeding. It is suitable for chronic hematuria and insomnia caused by kidney deficiency.

2. During radiotherapy for dietetic bladder cancer, when both qi and yin are injured, we should give priority to supplementing qi and nourishing yin, and choose fresh vegetables, fruits, spinach, water chestnut, walnuts, medlar and soft-shelled turtle.

3. During chemotherapy, both qi and blood were injured during chemotherapy. Appropriate qi and blood. Diet should be soft-shelled turtle, soft-shelled turtle, carp, chicken, eggs, mushrooms, tremella, bird's nest, hawthorn, ginkgo, sunflower, walnuts and other foods.

Third, surgical treatment.

(1) Indications for operation

The scope and method of specific operation should be comprehensively analyzed according to tumor stage, malignant degree, pathological type, tumor size, location and whether adjacent organs are involved. Different surgical methods have different indications. At the same time, it is necessary to consider the patient's physical fitness and ability to tolerate surgery to decide the surgical plan.

(2) the choice of surgical methods

1. Transurethral operation ① electrocautery: During cystoscopy, if non-invasive superficial papilloma (Ta stage), single tumor or a few scattered tumors with a tumor volume greater than 65438±0cm are found, transurethral electrocautery can be used at the same time. (2) Transurethral resection: it is suitable for pedicled papilloma about 2cm, or small tumor with massive or mulberry pedicle, and superficial bladder tumor that has not invaded deep muscle (T2 stage). Transurethral resection can be performed using an electrosurgical mirror.

2. The scope of application of local cystectomy and electrocautery is similar to that of transurethral surgery, that is, bladder papilloma with shallow infiltration, low malignancy and thin pedicle.

3. Partial cystectomy is suitable for invasive papillary carcinoma with limited scope, and the tumor should be far away from the triangle of bladder and bladder neck. The depth of infiltration should not exceed the fat layer around the bladder. Ureterovesical anastomosis is feasible when necessary.

4. Total cystectomy is not within the scope of the above surgical methods. The tumor is located in the triangle of bladder and bladder neck with infiltration, the tumor has metastasized to the surrounding lymph nodes, and the tumor recurs. Radical total cystectomy should be adopted. The severed ureter must undergo ureteral transplantation and other urinary diversion operations. Commonly used shunt operations are: ① ureterostomy; ② colostomy of rectum, bladder and sigmoid colon; ③ Rectal plasty; ④ Ileal bladder surgery; ⑤ controllable ileum to replace bladder bag.

Fourth, chemotherapy.

(1) Indications of chemotherapy

The recurrence rate of bladder cancer after simple resection is high, and because the bladder tumor is superficial after transurethral resection, chemotherapy is needed to increase the thoroughness of its treatment. On the other hand, combined chemotherapy can be used as palliative treatment for advanced bladder cancer with invasive cancer and distant metastasis, and plays an auxiliary role in the treatment of bladder cancer.

(2) Types of chemotherapy

1. Intraluminal chemotherapy for bladder cancer: high-concentration anticancer drugs are infused into the bladder, so that the anticancer drugs can directly act on bladder cancer. Kill the cancer cells in the bladder, including the remaining cancer cells after cystectomy. With little systemic toxicity and convenient application, it can well preserve the physiological functions of patients, and can be used to treat superficial bladder cancer or prevent recurrence after cystectomy. During the treatment, cystoscopy was reviewed every 3 months, changed to 6 months after 2 years, and changed to 1 year after 5 years. If the patient has gross hematuria during the follow-up, the possibility of recurrence should be considered and cystoscopy should be done in advance. At the same time, urine routine examination and exfoliated cell examination can be done regularly, and bladder meridian examination can be done at any time when suspicious circumstances are found.

(1) Treatment method: After the anticancer drug is diluted (the drug concentration is generally 1mg per milliliter of solution), it is poured into the evacuated bladder through a catheter and kept for 2 hours. In order to improve the curative effect, drinking water was restricted 8 ~ 12 hours before perfusion to reduce urine secretion and maintain the drug concentration in the bladder. After medication, the body position (supine position, lateral position and prone position) was changed every 15 minutes to make the liquid reach all parts of the bladder. Empty the bladder after two hours. Perfusion treatment is once a week, and after 6 times, it is changed to once a month for 2 years.

(2) Commonly used drugs: There are many drugs that can be used for bladder perfusion, but the following conditions need to be met: ① drugs easily penetrate into the bladder wall; ② Less systemic absorption; ③ Local stimulation is small, which does not cause cystitis and bladder fiber contraction. Commonly used drugs are:

TSPAP: 60mg TSPAP and 60ml normal saline were injected directly into bladder through urethra. In the treatment of superficial tumors, once a week 1 time, and once a month 1 time after 6 times for 2 years. The medicine has little toxic and side effects, low price and an effective rate of 40%.

Mitomycin (MMC): It has direct and indirect effects on bladder cancer, causing cytoplasmic degeneration and secondary necrosis of cancer cells. It is an ideal perfusion drug. After 1 ~ 2 weeks, 40mgMMC and 40ml normal saline were injected through the catheter. Once a week, * * * after 4 to 6 times, it will be changed to once every two weeks, and then once a month 1 year. The side effects are intense stimulation, cystitis and hematuria, and the effective rate is 66%.

Cisplatin (DDP): 60 mg DDP and 60ml normal saline were injected into bladder via catheter. Every 2 ~ 3 weeks 1 time, 4 ~ 8 times in total, and then every 2 months 1 time, for 2 years in total. The effective rate is 40%.

Adriamycin: 40 ~ 80 mg of adriamycin and 40 ~ 60 ml of normal saline were injected into bladder via catheter every 3 ~ 4 weeks 1 time for 2 years. The local reaction of this medicine is serious, and the effective rate is about 40%.

2. Interventional treatment of bladder Interventional chemotherapy is intubation chemotherapy of inferior epigastric artery. That is, the catheter is inserted through the inferior epigastric artery to the bifurcation of abdominal aorta for combined perfusion of chemotherapy drugs. In order to reduce the side effects of chemotherapy and increase the local drug concentration, tourniquet was used to temporarily block the blood flow in the thighs of both lower limbs when chemotherapy drugs were infused. This method is effective in the treatment of bladder cancer, which can make some tumors shrink, necrosis or disappear. It is characterized by high concentration of drugs in pelvic cavity, small systemic reaction and small drug irritation, and has effects on submucosa, muscularis, tissues around bladder and lymph nodes and venules involved. Therapeutic drugs can be used according to the following combination chemotherapy schemes.

3. Systemic chemotherapy Systemic chemotherapy is suitable for invasive bladder and metastatic advanced cancer or postoperative adjuvant therapy and postoperative recurrence cases. Systemic chemotherapy is effective for transitional cell carcinoma, but basically ineffective for squamous cell carcinoma, adenocarcinoma or mixed cell carcinoma. Systemic chemotherapy can be divided into single drug chemotherapy and combined chemotherapy.

(1) Single drug chemotherapy: The efficacy of commonly used drugs is as follows:

The effective rate of cisplatin 9 was 40%

The effective rate of adriamycin (ADM0) was 65438 0.5% ~ 35%.

The effective rate of methotrexate (MTX) was 28%

The effective rate of cyclophosphamide (CTX) was 22%

The effective rate of carboplatin (CBP) was 30%

The effective rate of mitomycin is 65438 03% ~ 37%.

The effective rate of vinblastine (VLB) is 15% ~ 35%.

The effective rate of 5-FU was 65438 07%.

(2) Combination chemotherapy: DDP is the main combination chemotherapy scheme at present because cisplatin is effective in the treatment of bladder cancer. The representative combination therapy is M-VAP, which is effective in controlling lymphatic metastasis and lung metastasis of transitional cell carcinoma, and also effective in bone and liver metastasis. It is not effective for non-transitional bladder cancer. Chemotherapy methods: MTX 30mg/m2 was given on days 1, 15 and 22 of chemotherapy, VLB 3mg/m2 on days 2, 15 and 22 of chemotherapy, adriamycin 30mg/m2 on days 2 and 3 of chemotherapy, and cisplatin 35mg on days 2 and 3 of chemotherapy. The toxic reaction of this scheme is very great, 20% of patients have septicemia, 4 1% have mucositis, and 4% have drug death. It should be used in hospitals with good conditions.

Another chemotherapy regimen is CISCA (or CAP) regimen. Chemotherapy method: CTX 650mg/m2 was given on the first day of chemotherapy, and ADM 50mg/m2 and DDP 70mg/m2 were given on the second day. 2 1 ~ 28 days is a cycle, and water should be replenished when DDP is applied. This regimen has a good curative effect on transitional cell carcinoma or transitional+squamous cell carcinoma, and the effective rate is 70%. It is not effective for adenocarcinoma or tumor mixed adenocarcinoma. The scheme has little toxic and side effects and is suitable for popularization and application.

Observation on the efficacy of other combined chemotherapy schemes in the treatment of bladder cancer;

The effective rate of cisplatin plus +CTX was 58/%

The effective rate of cisplatin +CTX+5-FU was 63%.

The effective rate of CTX+ adriamycin was 27%

The effective rate of adriamycin +5-FU was 40%.

The effective rate of cisplatin plus adriamycin was 5 1%.

The effective rate of cisplatin+adriamycin +5-FU was 44%.

The effective rate of DDP+VM-26 was 5 1%.

The effective rate of MTX+CTX+ adriamycin was 39%

Verb (abbreviation for verb) immunotherapy

From 1976, the clinical trial of intravesical instillation of BCG vaccine was started, and the application scope was gradually expanded. It is not only used to prevent postoperative recurrence of superficial bladder tumor, but also used to treat carcinoma in situ, residual tumor after operation and bladder cancer with muscular infiltration, and achieved good results. It is said that its curative effect is better than MMC bladder perfusion.

Usage: 120 ~ 150 mg of BCG and 50ml of normal saline were injected into the bladder through the catheter once a week, and once a month after six times, with a course of treatment of/kloc-0 for two consecutive years. Change body position every 15 minutes ***2 hours after perfusion. In order to prevent tumor recurrence, perfusion was started 2 weeks after operation.

Side effects and treatment: intravesical instillation of BCG can cause acute and chronic inflammation in bladder, various granulomas caused by inoculation outside bladder and other systemic toxic reactions of tuberculosis. Local and systemic reactions with mild symptoms and short duration do not need treatment. For those with complications and severe systemic reaction, bladder perfusion should be stopped and triple anti-tuberculosis drugs should be given at the same time.

Sixth, radiotherapy

The effect of radiotherapy for bladder cancer is not ideal, and the sensitivity is about 25%. Although it may have an effect on local recurrence, the general complications are more serious, so it is only used for palliative treatment of advanced patients or adjuvant treatment of patients undergoing surgery and chemotherapy.

Seven, laser and photodynamic therapy

It is a new development to introduce laser fiber into the organs of human body and treat diseases through endoscope. At present, laser treatment of bladder cancer is mainly suitable for superficial bladder tumors. The characteristics of laser treatment of bladder tumor stage are that laser has special biological effect, thermal effect, pressure effect, electromagnetic effect and immune effect. It has a certain penetrating effect and can destroy cancer tissue evenly.

Photodynamic therapy (PDT) is a combination of cystoscope laser and hematoporphyrin microorganism (HPD) for photodynamic therapy of bladder cancer. This is a selective treatment method for tumor cells, which has little damage to normal tissues, sensitive response and satisfactory treatment effect, and should be paid attention to.

Eight, heating therapy

Because the blood flow in the tumor is only 2% ~ 15% of the surrounding normal tissue, the tumor tissue has poor heat dissipation due to the lack of good blood circulation after heating, and the tumor cells are highly sensitive to heat, so the tumor cells are easily killed by heating, while the normal tissue is not affected. For patients with multiple superficial bladder cancer who cannot tolerate surgery, intravesical heating therapy can be used as adjuvant therapy.

Nine, biotherapy

It is a kind of therapy that has been studied more and has a broad prospect in recent years, and its large-scale effective application in clinic needs further efforts. At present, intravesical instillation of BCG, interleukin -2, systemic interferon, tumor necrosis factor and LAK cells can obviously improve the immune mechanism of human body and enhance its anti-cancer ability.

Biological holographic therapy

When a certain part of the body is sick, the relevant holographic acupoints will have a unique reaction, and massage or acupuncture according to the reaction tenderness points can treat the disease. Using holographic therapeutic apparatus, select acupoints according to acupoints, and use dense waves and sparse waves to relieve pain. Each treatment lasts for 20 minutes, 1 time per day, and 7 times is a course of treatment.