目的:观察应用新辅助化疗(NAC)联合根治性经尿道膀胱肿瘤绿激光汽化术(RPVBT)治疗肌层浸润性膀胱癌(MIBC)的疗效和安全性。方法:2012年10月~2014年10月收治因无法耐受或不愿接受根治性膀胱切除术的MIBC患者,排除不适合化疗者,共41例接受NAC联合RPVBT治疗。年龄46~82岁,平均61岁;肿瘤最大经线1.5~4.5cm,平均3.2cm。术前病理诊断为尿路上皮癌,临床分期为T2~T3a。采用吉西他滨+顺铂(GC方案)全身化疗2~3个疗程后行RPVBT,切除深度至膀胱外脂肪层,范围至肿瘤周围2cm。术后定期随访。结果:41例患者共接受116个疗程NAC,平均2.83个疗程。化疗后肿瘤最大径线1.5~4.0cm,平均2.4cm,较化疗前缩小(P<0.05);肿瘤临床分期降期者26例(63.41%);肿瘤数目较前减少者11例(26.83%);28例(68.29%)出现不同程度药物毒性反应。41例手术均顺利完成,手术时间12~75min,平均42.2min,无严重并发症。术后随访12~36个月,平均21个月。复发10例(24.39%),死亡1例。结论:NAC联合RPVBT治疗MIBC具有一定疗效,是不能耐受或不愿意接受根治性膀胱切除术患者可以选择的治疗策略。 Objective: To observe the efficacy and safety of neoadjuvant chemotherapy (NAC) combined with radical urethral vaporization of bladder cancer (RPVBT) in the treatment of mycotic invasive bladder cancer (MIBC). METHODS: From October 2012 to October 2014, 41 patients with MIBC who were intolerant or unwilling to undergo radical cystectomy were enrolled in this study. Of the 41 patients who were unsuitable for chemotherapy, 41 were treated with NAC combined with RPVBT. Aged 46 to 82 years, mean 61 years; the largest meridian tumor 1.5 ~ 4.5cm, an average of 3.2cm. Preoperative pathological diagnosis of urothelial carcinoma, clinical stage T2 ~ T3a. Patients were treated with gemcitabine + cisplatin (GC) for 2 to 3 courses of systemic chemotherapy followed by RPVBT. The depth of resection was removed to the extra-bladder fat layer, ranging from 2 cm around the tumor. Regular follow-up after surgery. Results: A total of 41 patients received 116 courses of NAC, an average of 2.83 courses. After chemotherapy, the largest diameter of tumor was 1.5-4.0 cm (2.4 cm in average), which was smaller than that before chemotherapy (P <0.05). The clinical stage of tumor was 26 cases (63.41%), the number of tumor was 11 cases (26.83% ; 28 cases (68.29%) showed varying degrees of toxicity. All the 41 cases were successfully completed. The operation time ranged from 12 to 75 minutes with an average of 42.2 minutes. There were no serious complications. The patients were followed up for 12 to 36 months with an average of 21 months. Recurrent in 10 cases (24.39%), 1 died. Conclusion: NAC combined with RPVBT has certain curative effect on MIBC, which is an optional treatment strategy for patients who can not tolerate or are not willing to undergo radical cystectomy.