直肠癌不同化疗方式区域淋巴结药物浓度比较

Comparison of drug concentration in lymph nodes of patients with rectal cancer after regional extended release chemotherapy and persistently intravenous chemotherapy

目的 比较直肠癌区域缓释化疗（regionalextended release chemotherapy，RERC）与持续静脉化疗（persistently intravenous chemotherapy，PVC）后区域淋巴结内药物浓度。方法将直肠腺癌患者随机分为RERC组和PVC组，每组20例。于手术前48h，RERC组在瘤周黏膜下植人中人氟安（5-氟尿嘧啶缓释剂）；PVC组经静脉化疗泵持续泵人5-氟尿嘧啶注射液，均为200mg。术中切除标本后摘取直肠癌肠上、肠旁、肠系膜血管旁和肠系膜血管根部淋巴结，进行病理检查和药物浓度检测。结果摘取淋巴结114枚，每组57枚，有8l枚转移，其中PVC组42枚，RERC组39枚。PVC组第l、2、3站淋巴结内药物浓度分别为（0．18±0．06）、（0．19±0．07）、（0．16±0．05）μg／g，RERC组第1、2、3站淋巴结内药物浓度分别为（4．41±1．03）、（1．05±0．27）、（0．08±0．04）μg／g，两组间比较差异有统计学意义（P〈0．001）。RERC组组内3站淋巴结药物浓度之间比较差异有统计学意义（P〈0．001）。不同癌转移状态淋巴结之间药物浓度比较差异无统计学意义（P〉0．05）。结论直肠癌患者术前用5．氟尿嘧啶缓释化疗剂行RERC可以在一定区域淋巴结内形成药物高浓度，较PVC在肿瘤所属区域淋巴结中的化疗药物浓度高。

Objective To compare the drug concentration in lymph nodes of patients with rectal cancer after regional extended release chemotherapy （RERC） and persistently intravenous chemotherapy （PVC）. Methods Patients with rectal adenocarcinoma confirmed by preoperative biopsy were randomized into RERC group （ n = 20） and PVC group （ n = 20）. Forty-eight hours before operation, 200 mg 5-Fluorouracil sustained release agent was injected into mucosa around tumor in RERC group, and patients in PVC group were persistently pumped with 200 mg 5-Fluorouracil intravenously. After specimen resection, the lymph nodes at or beside colon, at or beside the root of mesenteric blood vessel were removed immediately to detect drug concentration and take pathological examination. Results Fifty-seven lymph nodes of each group were resected, and lymph node metas- tasis occured in 81 including 42 in PVC group and 39 in RERC group. The concentrations of 5-Fluorouracil in lymph nodes at or beside colon （ station 1 ）, beside the root of mesenteric blood vessel （ station 2） and at the root of mesenteric blood vessel （ station 3 ） were （ 0.18 ±0.06 ） μg/g, （ 0.19± 0.07 ）μg/g, （0.16 ± 0.05 ） μg/g in PVC group and （4.41 ± 1.03 ） μg/g, （ 1.05 ±0.27 ） μg/g, （0.08 ±0.04） μg/g in RERC group, with statistical difference （ P 〈0.001 ）. The drug concentration in lymph nodes had statistical significance among the 3 stations in RERC group （ P 〈0.001 ）. There was no statistical significance upon the drug concentration among different statuses of lymph node metastasis （ P 〉 0.05 ）. Conclusions Compared with PVC, RERC can effectively and continuously improve drug concentration in local lymph nodes of patients with rectal cancer.