内镜直视下5-氟尿嘧啶缓释剂的安全性

Security of 5-fluorouracil sustained-release reagent under orthoptic endoscope

目的:采用内镜直视下将化疗缓释粒子植入到食道肿瘤组织、瘤体周围组织间质中,探讨食管癌术中植入缓释氟尿嘧啶间质化疗的安全性。方法:文献总结来源于检索Pubmed数据库1988-01/2008-12的相关文献及CNKI数据库2000-01/2008-12的相关文章。对资料进行初审,纳入标准:与食管癌采用5-氟尿嘧啶缓释剂治疗相关研究的文献。排除标准:重复性研究。临床验证病例选择2001-03/2007-12沈阳市红十字医院肿瘤科门诊或住院的Ⅲ～Ⅳ期食管癌、内镜下植入5-氟尿嘧啶缓释剂患者29例。男22例,女7例,年龄51岁～82岁,平均年龄60.2岁。在消化内镜直视下将5-氟尿嘧啶的缓释粒子植入到肿瘤间质。每例用800mg5-氟尿嘧啶分次植入,每次同时植入3～5粒。结果:文献报道食管癌术中植入氟尿嘧啶缓释剂有效安全。临床验证结果完全缓解3例,部分缓解16例,病情稳定6例,4例无缓解,体质量增加21例占72.4%,平均有效率为70.9%。不良反应除因术中操作出血外仅有白细胞轻度下降、轻度恶性、腹泻,无发生肝肾功能损害。有22例癌性疼痛缓解率为75.8%,可停用镇痛药占50%(P<0.05)。结论:胃肠道恶性肿瘤化疗缓释粒子内镜植入突出了局部靶向治疗,提高肿瘤部位的药物浓度,延长药物与癌细胞的作用时间,提高临床效果。经临床验证具有微创、安全、有效及并发症发生率低的特点。

OBJECTIVE： To explore security of interstitial chemotherapy by implanting 5-fluorouracil sustained-release reagent into interstitial tissues of oesophageal tumor tissue and tumor peripheral tissue under orthoptic endoscope. METHODS： Relative articles were retrieved from Pubmed database from January 1988 to December 2008 and CNKI database from January 2000 to December 2008. Inclusion criteria： articles which were related to 5-fluorouracil sustained-release reagent for the treatment of esophageal carcinoma were included; Exclusion criteria： Duplicated articles were excluded. A total of 29 patients with grade Ⅲ-Ⅳ esophageal carcinoma who received implantation of 5-fluorouracil sustained-release reagent under orthoptic endoscope were collected from Department of Oncology, Shenyang Red Cross Hospital from March 2001 to December 2007. There were 22 males and 7 females, aging 51 82 years and mean age of 60.2 years. 5-fluorouracil sustained-release particles were implanted into tumor interstitial tissue under orthoptic endoscope. 800 mg 5-fluorouracil sustained-release particles were gradually implanted for 3 5 particles each time. RESULTS： Implantation of 5-fluorouracil sustained-release reagent has been reported to safely and effectively treat esophageal carcinoma. Clinical results indicated complete remission （n=3）, partial remission （n=16）, stable pathogenetic condition （n=6）, and no remission （n=4）. Body mass increased in 21 patients （72.4%）, and average effectiveness level was 70.9%. Symptoms including hemorrhage, light descent of leukocyte, light malignancy, diarrhea but excluding functional disorder of liver and kidney were found. Easement of pain in 22 patients was 75.8%, and discontinuing analgesics accounted for 50% （P 〈 0.05）. CONCLUSION： Endoscopic implantation of chemotherapeutic slow-release ion for the treatment of gastrointestinal malignant tumors, characterizing by microtrauma, security, efficiency, low-incidence of complication, may emphasize target therapy in local region, increase drug concentration, prolong the action time of drug on cancer cells, and enhance clinical effects.