内镜化疗粒子植入缓解进展期胃癌梗阻症状观察

Endoscopic implantation of slow-releasing 5-fluorouracil in relieving incomplete malignant gastric outflow obstruction

目的:对12例进展期胃癌浸润引起胃流出道不全梗阻患者行内镜下缓释5-氟尿嘧啶(5-FU)粒子植入治疗,观察其缓解不全梗阻的疗效。方法:内镜下对胃癌梗阻部结节及浸润处多点或密集型植入粒子(每粒含5-FU1.67 mg)45～60粒,平均注射5-FU缓释粒子90 mg。癌灶旁另注射香菇多糖注射液3 mg。结果:12例患者共施行粒子植入治疗16次,未发生出血、穿孔等并发症;肝、肾功能及血常规检查未见异常。缓解不全梗阻显著有效3例,明显有效4例,有效3例,无效2例,总有效率83.3%。1次治疗后症状缓解持续时间平均22 d。2例患者不全梗阻症状缓解后转外科手术治疗。结论:植入用缓释5-FU局部抗癌持续时间为15～30 d,作用时间远长于静脉或局部注射水剂化疗药物,对缓解胃癌浸润引起的流出道梗阻、改善患者全身状况有一定作用,并能为部分患者转行外科手术创造时机和条件。

Objective To observe the efficacy of endoscopic implantation of slow-releasing 5-fluorouracil （5-FU） in relieving incomplete gastric outflow obstruction due to locally-advanced carcinoma. Methods A total of 12 advanced gastric cancer patients enrolled into this study. During the endoscopy procedure, slow-releasing 5-FU agent was implanted compactly into the infiltrated tumor lesion. Forty-five to sixty pieces of agent （each piece equivalent to 1.67 mg 5-FU） were deployed, with an average dose of 90 mg. Simultaneously, 3 mg lentinan was injected surround the infiltrated lesions. Results Sixteen procedures of slow-releasing 5-FU implantation were performed. No hemorrhage or perforation was observed. Parameters of hepato-renal function and complete blood count were stable after implantation. The numbers of patients with satisfactory, very good and good results in relieving symptom were 3, 4 and 3 respectively, with an overall response rate of 83.3%（10/12）. The average time of sustained symptom-relieving was 22 d. Two patients were transferred to gastrectomy after pertinent symptoms relievement following slow-releasing 5-FU implantation. Conclusions The time of sustained obstructive symptom-relieving after slow-releasing 5-FU implantation ranges from 15 to 30 d, much longer than that of conventional chemotherapy via either intravenous or locally applied water-soluble agents. Satisfied results have been observed in relieving incomplete gastric outflow obstruction due to tumor infiltration, and improving the performance status of patients.