超选择性动脉灌注化疗在口腔鳞状细胞癌新辅助化疗中的应用

Application of super-selective intra-arterial infusion chemotherapy in the neoadjuvant chemotherapy for oral squamous cell carcinoma

目的:探讨应用数字减影血管造影技术(Digital subtraction angiography,DSA)进行超选择性动脉灌注化疗在口腔鳞状细胞癌(Oral squamous cell carcinoma,OSCC)新辅助化疗中的应用。方法:选择2010年1月至2011年2月间重庆医科大学附属第一医院颌面外科收治的6例T3或T4的口腔舌鳞癌患者,均为颞浅动脉逆行插管失败的病例,原因为颈外动脉变异导致导管逆行插入颌外动脉或颌内动脉内而不能到达舌动脉水平。在局麻下经皮股动脉穿刺超选择性将STD125-26S导管置于舌动脉内5～6 cm,术后第2天起选择"卡铂+氟尿嘧啶"舌动脉灌注化疗1疗程,观察原发灶的变化、术后并发症、化疗的毒副作用。结果:6例患者中2例原发灶消失,经活检、病理连续切片证实未见癌细胞;4例原发灶缩小均大于50%;未见明显术后血管意外并发症或伤口感染;化疗毒副作用少。结论:超选择性动脉灌注化疗应用于OSCC的新辅助化疗,操作简单,并发症少,毒副反应轻,特别适合因血管变异导致颞浅动脉泵植入失败的病例。

Objective：To study the application of digital subtraction angiography（DSA） in the super-selective intra-arterial infusion as the neoadjuvant chemotherapy for oral squamous cell carcinoma.Methods：From January 2010 to February 2011,6 patients with T3 or T4 oral squamous cell carcinoma of the tongue in our department were chosen to undergo super-selective intra-arterial chemotherapy through the superficial temporal artery.However,failure of all cases were noticed.The reason for this was the external carotid artery variation causing the inverted insertation of catheter into the internal maxillary artery or the external maxillary artery without reaching lingual artery.Under local anesthesia STD125-26S microcatheter was super-selectively posted into lingual artery about 5～6 cm by via per cutem femoral artery puncture using DSA.The next day＇carboplatin plus 5-fluorouracil＇ lingual arterial infusion chemotherapy was started,and change of the primary foci,the postoperative complications,the toxic side effects of chemotherapy were observed.Results：In six patients,foci in 2 patients disappeared,and cancer cells were not found by biopsy or pathologic serial section cutting.Primary foci in other 4 patiens shrank more than 50% of their original sizes.No noticeable postoperative vascular accidental complications or wound infections were observed.Toxic side effects of chemotherapy were minimal.Conclusion：The application of super-selective arterial perfusion in the new adjuvant chemotherapy for oral squamous cell carcinoma is simple with less complications and side effects,which is especially suitable for patients with vascular variation causing failed implantation of superficial temporoparietal artery pump.