丝裂霉素在癌性疼痛治疗中的应用

Application of mitomycin-C in reliving cancerous pain

目的:观察应用丝裂霉素(MMC)对癌性疼痛治疗效果,探讨其作用机理。方法:16例晚期癌痛病人以1～2mg/ml浓度使用4～8mgMMC行椎管内、骶管、神径丛(干)注射,每日或隔日一次,3～4次,观察止痛效果;采取人离体坐骨神经锐性分段后分别浸泡于生理盐水及不同浓度MMC溶液中1～24小时作切片对比观察其病理损伤程度。结果:16例病人获得2～6周的疼痛缓解,其中9例停用麻醉性镇痛药,7例仍需投用吗啡缓释剂但剂量减少1/2～1/3,无严重不良反应。病理切片可见:神经纤维萎缩排列紊乱,鞘膜以空泡样变为主。结论:MMC可缓解癌性疼痛,其机理可能与鞘膜空泡变性影响其兴奋传导及减轻肿瘤对神经的压迫有关。

Objective: To observe the effects of reliving cancerous pain with mitomycin C(MMC). Method:Sixteen patients with terminal cancerous pain received epidural, sacral or neuroplexus administration of MMC 4-8mg (concentration:1-2mg/ml) once a day or every other day, lasting 3-4times and degree of pain relief was evaluated. In different concentration solutions of MMC and normal saline, the pathologic changes of separated nerve of live body in sharp dissection, immersed for 1-24hours (37℃), was observed under microscope. Result: All patients got a good pain relief for 2-6 weeks, nine of them did not required any narcotic analgesic, the other cases needed analgesics, but the dosage required was reduced by 1/2-1/3 and adverse effects did not occur. Pathologic results showed that nerve fiber atrophy appeared with range disturbance, neurilemma changes were dominated by fatty degeneration. Conclusion: MMC can relive cancerous pain,through producing fatty degeneration of neurilemma to reduce excitatory transmission and alleviating nervous constriction of tumor.