晚期直肠癌术前选择性动脉灌注化疗对手术和血管内皮细胞生长因子、微血管密度的影响

Effect of selective rectal artery chemotherapy before resection on operation and microvessel density and vascular endothelial growth factor in advanced rectal carcinoma

目的探讨术前选择性动脉灌注化疗治疗晚期直肠癌对手术切除、血管内皮细胞生长因子(VEGF)和肿瘤血管密度(MVD)的影响。方法选择该院2006年8月至2010年6月收治的直肠癌患者62例,随机分为选择性动脉灌注化疗加手术组(治疗组)32例和单纯手术组(对照组)30例。灌注化疗方案为替加氟800mg、亚叶酸钙100mg、奥沙利铂150mg。比较两组患者治疗后组织VEGF阳性率与MVD计数。结果治疗组介入治疗后体积(37.21±11.15)cm3较治疗前(48.57±10.43)cm3明显缩小,差异有统计学意义(P<0.05)。治疗组21例行根治手术,对照组15例行根治性手术。治疗组术中出血量(86±24)mL较对照组(158±36)mL少(P<0.05)。治疗组VEGF阳性表达率较对照组显著降低(P<0.05),平均微血管密度亦较对照组明显下降(P<0.05)。结论晚期直肠癌术前行选择性动脉灌注化疗可减小肿瘤体积,增加手术切除率,其机制可能与下调VEGF表达和MVD值抑制肿瘤的血管生成有关。

Objective To investigate the effect of selective rectal artery chemotherapy before resection on operation and microvessel density and vascular endothelial growth factor in advanced rectal carcinoma.Methods From Aug 2006 to Jun 2010,62 cases of rectal carcinoma,were divided into therapeutic group,32 patients were treated with selective rectal artery chemotherapy and operation,and control group,30 patients were treated with operation only.selective rectal artery chemotherapy regimens：tegafur ＋ calcium folinate ＋ oxaliplatin.The positive rate of VEGF and MVD were performed between two groups.Results In therapeutic group,the volume of tumor after therapy was less than that of before treatment（P〈0.05）.There were 21 cases treated by radical resection in therapeutic group,but 15 cases in control group.The blood loss of operation in therapeutic group was（86±24）mL,which less than that of control group（158±36）mL.Compared with control group,the positive rate of VEGF and MVD were decreased obviously in therapeutic group（P〈0.05）.Conclusion The therapy of selective rectal artery chemotherapy before resection in advanced rectal carcinoma can reduce the tumor volume and operation risk,and the mechanism may be relate with down regulation of VEGF and MVD,and further inhibition of tumor angiogenesis.