应用电化学疗法和腹腔化疗泵注射治疗中晚期胰体尾癌

Electrochemical therapy and implanted ports treatment for unresectable carcinoma of body and tail of pancreas

目的 探讨电化学疗法对中晚期胰体尾癌的治疗效果及其安全性。 方法 1989年 5月至 1996年 6月应用电化学疗法治疗中晚期胰体尾癌 18例 (A组 ) ;1996年 7月至 1999年 9月治疗16例 (B组 ) ,除术中应用电化学治疗外 ,术后经腹腔化疗泵注射化疗 (5 氟尿嘧啶 5 0 0mg,甲酰四氢叶酸钙 30 0mg以及卡铂 2 0 0mg,每周 1次 )。 结果 (1)两组患者肿瘤大小都有不同程度缩小或消失 ;(2 )两组患者均有较好的止痛效果 ;(3)腹水控制 :A组无效 ,B组部分有效 (6 6 7% ) ;(4 )两组患者均无手术死亡及严重并发症。 结论 电化学疗法对于中晚期胰体尾癌是一种安全有效的治疗手段 ,可以减轻痛苦 ,改善生活质量。

Objective To examine the efficacy and safety of electrochemical therapy (ECT) in treatment of patients with unresectable carcinoma of the body and tail of pancreas. Methods A total of 18 patients (14 men and 4 women; mean age 57 7) with unresectable carcinoma of the body and tail of pancreas were treated by ECT between May 1989 and June 1996 in our hospital (group A). Another 16 patients (12 men and 4 women; mean age 60 3) were treated by ECT plus intraperitoneal chemotherepy between July 1996 and June 1999 (group B). In group B, ECT was used during the operation. Meanwhile, 300 mg calcium leucovorin (CF), 500 mg 5 FU and 200 mg carboplatin were injected weekly into the abdominal cavity through the implanted ports. Pain was determined by using a 10 point visual analog pain scale (VAS) before and after the treatment, life quality periodically assessed according to the 5 step scale system, and tumor size measured using CT or MRI. Results All the patients were followed up for 5～30 months (mean=10 months), showing that there were no operative deaths and such complications such as pancreatic fistula and bleeding in both groups. The tumor size in both groups was decreased to some degree. Ascites in 4 of 6 cases in group B were well controlled, whereas there was no changes in 6 cases of ascites in group A. In group A, the VAS basal score was reduced from 7 4±1 7 before to 2 66±1 05 after the treatment and the peak VAS from 9 3±0 9 to 3 71±0 96 ( P <0 05). In group B, they were decreased from 7 5±1 5 to 2 17±1 23 and 9 2±0 9 to 3 4±1 13, respectively ( P <0 01). Significant reduction of VAS score persisted for over 3 months after ECT. The satisfaction rate in group B was 37 5%, 62 5% and 25% in 7 days, 1 month and 3 months, respectively. Conclusions ECT is a safe and effective procedure for treatment of unresectable carcinoma of the body and tail of pancreas and in relieving its pain and improving the life quality of patients. Supplementary injection of chemical drugs through drug delivery pump is helpful for control of ascites.