直肠癌术中区域化疗的临床意义

Clinical Significance of Regional Chemotherapy Intraoperation for Rectal Cancer

[目的]探讨直肠癌术中区域化疗的临床意义。[方法]直肠癌术中经区域动脉灌注含5-Fu(15mg/kg)化疗液,高效液相色谱法测定样本5-Fu浓度,术后观察肿瘤标本组织病理学改变。[结果]各样本注药后2min即出现峰浓度,盆腔渗出液浓度最高216.44±29.69μg/ml,癌旁组织(27.18±6.98μg/ml),门静脉血药浓度(75.64±9.80μg/ml)高于周围静脉血(57.17±6.17μg/ml);病理检查发现癌细胞出现轻度细胞核固缩、肿胀,细胞浆凝固、坏死,细胞间质轻度水肿,炎性细胞浸润,部分病例可见轻度血管炎表现。透射电镜发现治疗组癌细胞间隙明显增大。[结论]直肠癌术中区域化疗可使盆腔渗出液、门静脉血和癌旁组织维持高的药物浓度,改变癌组织的组织学形态,对预防直肠癌术中癌细胞扩散和术后复发具有积极作用。

[Purpose] To investigate the clinical significance of regional chemotherapy intraoperation for rectal cancer. [Methods] Rectal cancer patients underwent regional arterial chemotherapy intraoperation with 5-Fu（15mg/kg）. Concentration of 5-Fu in samples was determined by high pressure liquid chromatography （HPLC）. Histopathological change of tumor were examined postoperation. [Results] The peak concentration in samples revealed on 2min. The concentration of peritoneal fluid was the highest （216.44±29.69μg/ml）, the lowest in the paracancerous tissue （27.18±6.98μg/ml） and the concentration in portal vein （75.64± 9.80μg/ml） was higher than that in peripheral blood （57.17±6.17μg/ml）. Mild cytoplasmic karyopyknosis, nuclear swelling, coagulation and necrosis in cancer cells, light hydropsia of intercellular substance, invasion of inflammatory cells and inflammation of vessels were found. The increase of intercellular space was observed under electron microscope. [Conclusion] Regional chemotherapy intraoperation for rectal cancer enable maintaining a high concentration of chemotherapy in portal vein, peritoneal fluid and paracancerous tissue, as well as altering histopathologic morphology of the tumor. It plays an active role in prophylaxis of cancer spreading intraopertion and recurrence postoperation.