卡铂腹腔化疗腹膜后淋巴结内的药物浓度

The study of platinum concentration in retroperitoneal lymph nodes after intraperitoneal carboplatin in ovarian tumors

对２３例卵巢恶性肿瘤患者，分别于术前不同时间进行腹腔穿刺并灌注卡铂（３００ｍｇ／ｍ￣２），手术清扫腹膜后淋巴结，同时切取盆腔腹膜和髂外淋巴结周围脂肪结缔组织各１ｇ，用无火焰原子吸收光谱法分别测定上述３种组织的总铂浓度，并监测３例患者给药后２４小时内的血浆总铂浓度，以及观察化疗后腹膜后淋巴结的病理改变。结果显示，腹膜后淋巴结内总铂浓度在腹腔给药后１２小时达到高峰，峰值为１３．４±１．９～２１．６±７．８μｇ／ｇ。腹主动脉旁淋巴结、盆腔淋巴结、淋巴结周围脂肪结缔组织和盆腔腹膜总铂浓度的药时曲线下面积（ＡＵＣ＿（０～２４ｈ））分别为２１６．８±９．２、２４６．４±３２．９、１１５．６±４０．９和１３５１．３±６９６．５μｇ·ｈ／ｇ。血浆总铂浓度的峰值及ＡＵＣ＿（０～２４ｈ）分别为６．７±１．０μｇ／Ｌ和６１．５±２．４μｇ·ｈ／Ｌ。提示卡铂腹腔给药分布于腹膜后淋巴结组织中的药物浓度较血药浓度明显为高。病理检查可见化疗后的腹膜后淋巴结有变性改变。

wenty three patients with ovarian tumors were given intraperitoneal carboplatin(300mg/m￣2)atdifferent times before laparotomy and retroperitoneal lymphadenectomy.Total platinum (Pt)concentra-tions in the nedes, the peritoneum and other tissues were measured by flameless atomic absorption spec-trometry. Histologic examinations were carried out for the nodes.In addition, Total platinum concen-tration of the plasma was determined in 3 cases.Peak Pt concentration in retroperitoneal nodes reachedat 12th hour after instillation,and the peak value was 13. 38±1. 85～21. 57±7. 80μg/g,its AUC_(0～24h)was 216.8±9.2～246.4±32. 9μg·h/g. AUC_(0～24h) for the fatty and connective tissues around thepelvic nodes was 115.6 ± 40. 9μg·h/g; it was significantly lower than AUC_(0～24h) for the nodes.AUC_(0～24h) for the pelvic peritoneum was 135 1.3 ± 696.5μg·h/g. Peak concentrations in the plasmawere reached at the second hour after intraperitoneal carboplatin, Its peak value and AUC_(0～24h) were 6.7±1. 0μg/L and 61.5±2. 4μg·h/L respectively. They were obviously lower than those for the nodes. These results indicate that after intraperitoneal carboplatin concentrations of the drug are higher in theretroperitoneal nodes than in the blcod. Post chemotherapeutic histological cytodegeneration is found inthe lymph nodes in some cases.