肾动脉灌注化疗联合栓塞与免疫治疗巨大肾癌32例

Combination of arterial infusion chemotherapy and embolization for the treatment of giant carcinoma of kidney in 32 cases

目的 探讨巨大肾癌动脉灌注化疗联合栓塞免疫治疗的疗效。方法 1990年4月～2003年4月，我院对32例巨大肾癌行动脉灌注栓塞术，灌注抗癌药物为表阿霉素30～40mg、丝裂霉素20～30mg、5-FU 500mg；应用无水酒精、5％鱼肝油酸钠、40％碘油加明胶海绵颗粒施行肾动脉栓塞；干扰素和白介素-2辅助治疗。结果 32例均成功施行动脉灌注栓塞术。8例栓塞术后l～3个月实施手术切除，术中见肿瘤血供基本中断，病理见肿瘤细胞坏死明显，周边有少许炎性淋巴细胞及不同程度纤维增生，毛细血管栓塞。总有效率为87．5％（28／32），6个月及1、2、3年生存率分别为78．1％（25／32）、68．8％（22／32）、46．9％（15／32）、31．2％（10／32），平均生存期41．5月。结论 肾动脉灌注化疗联合栓塞与免疫治疗巨大肾癌，临床疗效较好。

Objective To explore the efficacy of arterial infusion chemotherapy combined with embolization for the treatment of giant carcinoma of the kidney. Methods Arterial infusion chemotherapy combined with embolization was performed through the renal artery in 32 cases of giant carcinoma of the kidney from April 1990 to April 2003. The chemotherapeutic agents were epirubicin （30～40 mg）, mitomycin （20 ～ 30 mg）, and 5-FU （500 mg）. The embolization was conducted with anhydrous alcohol, sodium morrhuate, and lipiodol plus gelatin sponge. Results The arterial infusion and embolization was successfully administered in all the 32 cases. Surgical resection was accomplished in 8 cases 1 ～ 3 months after the embolization, and little or no blood supply to the tumor was seen during the surgery. Pathological findings revealed marked necrosis of tumor cells with inflammatory cell infiltration around and fibrous proliferation as well as capillary embolization. The total response rate （ CR ＋ PR） was 87. 5% （ 28/32 ） and the tumor decreased in size in 90.6% of the cases （29/32）. The survival rates at 6 months, 1 - , 2 - , and 3 -year were 78.1% （25/32） , 68.8% （22/32） , 46.9% （15/32） , and 31.2% （10/32） , respectively. The mean survival time was 41.5 months, with the longest time of 84 months. Conclusions Combination of infusion chemotherapy and embolization through the renal artery for the treatment of giant carcinoma of the kidney offers good clinical effects.