丝裂霉素纤维蛋白凝胶缓释化疗胃肠道低分化腺癌的临床研究

Sustained-release chemotherapy with mitomycin fibrin gel for gastrointestinal poorly differentiated adenocarcinoma

目的:本研究以丝裂霉素纤维蛋白凝胶缓释化疗胃肠道低分化腺癌T4期残留病灶,观察肿瘤局部复发及淋巴转移情况,并且了解局部化疗对全身的影响。方法:术中制备丝裂霉素纤维蛋白凝胶喷涂在实验组术者腹腔内残留病灶或瘤床周围,并用标记物标记出残留范围或瘤床范围,而对照组未使用。观察两组:(1)术后1,3,6,12,18个月,复查CT,了解肿瘤局部复发情况及淋巴转移情况。(2)术后7d内复查血常规、尿常规、肝肾功能、电解质,并且观察术后的患者的化疗不良反应及病情变化,了解局部化疗对全身的影响。结果:试验组局部标记病灶6个月进展者1例,12个月进展者3例,18个月进展者5例,随诊18个月15例患者局部标记范围病灶无进展;对照组局部标记病灶3个月进展者1例,6个月进展者3例,12个月进展者7例,18个月进展者13例,随诊18个月7例患者复查局部肿瘤无进展。术后7d所有病例均未观察到出现化疗不良反应。随诊18个月对照组和实验组的局部病灶情况比较差异有统计学意义(P<0.01)。结论:丝裂霉素纤维蛋白凝胶缓释化疗对T4期的胃肠道低分化腺癌术中局部残留的病灶有抑制作用,并且全身毒副反应轻微。

Objective： To evaluate the effects of sustained-release chemotherapy using fibrin glue enwrapping mitomycin （MMC/FG） for gastrointestinal poorly differentiated adenocarcinoma. Methods： All patients with gastrointestinal poorly differentiated adenocarcinoma after surgical resection of the primary tumor were randomly treated with （experimental group） or without （control group） MMC/FG. For the experimental group, MMC/FG was sprayed onto the residual tumor or around the base of the removed tumor. The residual area or bed of the removed tumor were marked for observation. Inspect local tumor recurrence and lymphatic metastasis by CT scan 1,3, 6, 12 and 18 months after chemotherapy; observe side reactions and the general condition of the patients; implement routine blood and urine test, liver and kidney function examination 7 days after the treatment. Results： 6, 12 and 18 months later, there were 1, 3 and 5 cases in the experimental group were evaluated as progression disease respectively, while 1, 3, 7 and 13 cases in the control group were evaluated as regression disease 3, 6, 12, and 18 months after surgery. According to the 18 months follow up, 15 and 7 cases of the experimental and control group showed no progression, there were significant differences between the observed local lesions of these two groups. There were no severe chemotherapy side reactions being observed 7 days after the surgery. Conclusion： Sustainedrelease chemotherapy using fibrin glue enwrapping mitomycin （MMC/FG） have inhibitory effects on localized residual of gastrointestinal poorly differentiated adenocarcinoma with edurable toxicity.