内镜下淋巴化疗对胃癌淋巴转移的疗效研究

Efficacy of lymphatic chemotherapy under endoscope for treatment of gastric cancer with metastasis

目的:探讨术前淋巴化疗对胃癌复发转移的影响,在胃癌围手术期的临床应用。方法:将60例Ⅲ期胃癌患者随机分为两组,淋巴化疗组30例,对照组30例。在改良根治术前3-5天,淋巴化疗组于肿瘤周围或瘤床注射纳米炭+丝裂霉素+氟脲嘧啶混合液,在内镜下经专用注射针向病灶旁0.5-1.0cm处分4-6个部位进行注射,每个部位注射0.5-1ml上述混合液,内镜注射化疗药后尽快进行肠道手术前准备,3-5天内进行根治性手术,对照组:选注射用丝裂霉素和5-氟脲嘧啶,常规进行全身静脉化疗,观察病人用药后的不良作用。对照组全身静脉化疗后手术,比较两组的新辅助化疗方案近期疗效、不良反应、手术视野染色情况、肿瘤组织及区域淋巴结变性坏死情况。结果:淋巴化疗组和对照组原发灶疗效总有效率分别为76.7%(23/30)和70.0%(21/30),两组差异无显著性(P>0.05)。不良反应以白细胞数下降的发生率最高,淋巴化疗组发生率达77.6%,Ⅲ度以上发生率为24.3%;对照组发生率达100%,Ⅲ度以上发生率为35.0%,发生率明显高于淋巴化疗组,差异有显著性(P<0.05)。淋巴化疗组和对照组清除的淋巴结转移率分别为45.1%(64/142)和44.6%(58/130),两组差异无显著性(P>0.05)。两组坏死率分别为90.6%(58/64)和50%(30/60),差异有显著性(P<0.05)。结论:肿瘤内抗癌药物注射是消化道癌肿病人辅助化疗、预防淋巴组织转移和复发的有效途径。与全身静脉化疗相比,内镜下肿瘤内给药效果较好,应用也较广。

Objective：To evaluate the therapeutic effect and side effects of lymphatic chemotherapy under endoscope versus intravenous chemotherapy（IC） in stages Ⅲ gastric cancer operated.Methods：sixty cases of gastric cancer were randomized into 2 groups：Lymphatic chemotherapy group（n=30）,receiving injection with carbon nanoparticles,MMC（mitomycin） and fluorouracil in the tissue aroun the primary tumor 3-5 day befor modified radical resection and control group（n=30）with whole body vein chemotherapy with 5-FU plus MMC.The dissected lymph nodes and the staining lymph nodes were counted.The specimens of lymph nodes were observed microscopically.Results：The overall response rates（RR） in two groups were 76.7 %（23 /30）and 70.0%（21 /30） respectively.The metastatic rate of eliminated lymph nodes in lymphatic chemotherapy group was similar with that in control group,45.1%（64/142） and 44.6%（58/130）,respectively（P0.05）.The necrosis rates of eliminated lymph nodes in two groups were 90.6%（58/64）and 50%（30/60） respectively（P0.05）.Conclusion：Lymphatic chemotherapy is the optimal scheme as neoadjuvant chemotherapy for advanced gastric cancer.