术前介入化疗结合手术治疗进展期直肠癌

TREATMENT OF ADVANCED RECTUM CANCER USING PREOPERATIVE INTERVENTION CHEMOTHERAPY AND OPERATION

目的 :观察进展期直肠癌术前介入化疗后对癌细胞生长的影响 ,瘤体的变化 ,为临床化疗提供理论依据 ,提高手术切除率。方法 :应用 Seldinger法经皮经股动脉穿刺插管 ,选择供应肿瘤的动脉一次性灌注化疗药物 ,丝裂霉素 C15 m g/ m2 ,阿霉素 35 mg/ m2 ,然后进行碘油栓塞 ,5氟脲嘧啶 (5 - FU ) 6 0 0 mg/ m2 与碘油 10 ml混合 ,最后进行肿瘤供应动脉的栓塞。分别于 2 4 h、 4 8h和 7d取肿瘤组织活检 ,应用末端脱氧核苷酸转移酶 (Td T)介导的原位标记法检测凋亡细胞 ,结果进行统计学分析。结果 :经过介入化疗后 2 4 ,4 8h和 7d细胞凋亡指数分别为 (2 0 .14± 3.4 )‰、 (12 .6 6± 3.12 )‰、 (11.5 6±3.6 )‰ ,明显高于化疗前的 (7.12± 1.78)‰。结论 :对于进展期直肠癌术前的介入化疗可使瘤体生长缓慢或缩小 ,提高手术切除肿瘤的机会 ,其机理主要是可能通过诱导癌细胞的凋亡以及肿瘤供应血管的栓塞 。

Objective: To observe influence on cancer cell growth and the variety of the lump by using intervention chemotherapy before the operation on the progressing rectum cancer, provide theories for clinical chemotherapy and improve excision rate of hiht surgical operation Methods: Seldinger method was applied to centesis of the femoral artery and intubatton Choosing the artery to inject with Mitomycin c 15 mg/m\+2 and Adriamucin 35 mg/m\+2,then proceed the iodine oil bolt into the artary:5 FU 600 mg/m\+2 s and iodine oil 10 ml mixture, respectively in 24 hours, 48 hours and 148 hours biopsy Using the method of TdT and microscope, we determined the apoptosis of the tumor cells and consequently proceeds to statitics and analysis Results: 24,48 and 148 hours apoptosis indexes were(20 14±3 4)‰,(12 66±3 12)‰,(11 56±3 6)‰,obviously higher than the chemotherapy front Conclusion: For the progressing rectum cancer, preoperative regional chemotherapy can effectively inhibit the tumor growth and increase the opportunity to remove the tumor by inducing the apoptosis of tumor cells and embolize the tumor blood vessels