大肠癌术前经导管动脉灌注化疗的临床价值

The Clinical Values of Preoperative Transcatheter Arterial Infusion Chemotherapy for Colorectal Carcinoma

目的 评价术前经导管肠系膜上、下动脉灌注抗癌药物治疗大肠癌的临床价值。材料与方法 病理证实的 5 1例大肠癌术前选择性肠系膜上、下动脉插管灌注抗癌药物 1～ 2次 ,5～ 3 0天 (平均 12天 )后行手术切除 ,标本送病理切片行组织学疗效观察 ,病例术后随访。结果 肿瘤组织学疗效有效率 98.0 % ,临床症状明显改善率 90 .2 % ,手术根治性切除率 92 .1%。随访时间 3～ 75个月 ,其中随访 2 4个月以上 3 2例 ,随访 60个月以上 15例 ,1、3、5年生存率分别为 92 .9%、76.6%、72 .8% ;术后 2年内复发率为3 .1% ( 1/ 3 2 ) ;动脉灌注化疗后 3天发生急性肠梗阻 3例 ,发生率为 5 .9% ( 3 / 5 1)。结论 术前经导管动脉灌注抗癌药物治疗大肠癌组织学疗效显著 ,可减轻患者临床症状 ,提高手术根治率 ,降低术后转移率和复发率 ,可提高生存率。

Objective To evaluate preoperative transcatheter via superior mesenteric artery (SMA) or inferior mesenteric artery (IMA) anticarcinogen infusion in treating colorectal carcinoma.Materials and Methods The clinical effect and histological response of transcatheter SMA or IMA anticarcinogen infusion for colorectal carcinoma in 51 pathologically proved cases were evaluated. The surgery was performed 5～30 days after arterial infusion (mean 12 days).Results The histological and clinical effectiveness rate were 98.0% and 90.2%, respectively. The radical operation rate was 92.1%. The following up period varied from 3 to 75 months. Of 32 cases who were followed up for over 24 months, 15 cases were followed for more than 60 months. The survival rate of 1, 3 and 5 years were 92.9%, 76.6% and 72.8%, respectively. Recurrence within 2 years was 3.1% (1/32). Acute intestinal obstruction was seen in 5.9% (3/51) cases within 3 days after arterial infusion.Conclusion Preoperative transcatheter via SMA or IMA anticarcinogen infusion has marked therapeutic effect for colorectal carcinoma both clinically and histologically. It can improve the radical operation rate, decrease the metastases and recurrence, increase the long term survival rate.