区域性动脉灌注化疗并栓塞对不能手术的恶性肠梗阻的临床应用

Clinical application of regional arterial infusion chemotherapy together with embolization in treating inoperable malignant bowel obstruction

目的评价区域性动脉灌注化疗并栓塞对不能手术恶性肠梗阻的临床应用价值。方法回顾分析不能手术的恶性肠梗阻患者86例，行区域性动脉灌注化疗或配合栓塞治疗。计算治疗肠梗阻的有效率和显效时间。比较不同肿瘤肠梗阻的无进展生存时间和总生存期。结果肠系膜上动脉置管持续灌注化疗35例，肠系膜下动脉灌注化疗及栓塞51例，并双侧髂内动脉灌注化疗16例。同时行肠系膜上、下动脉灌注化疗7例。灌注化疗及栓塞1～8次，平均3．62次。初次治疗后肠梗阻开始缓解时间4—156h，平均22．5h。有效率为89．5％（77／86）。肠梗阻持续缓解时间2-16个月，平均（7．03±3．02）个月。从发生肠梗阻计算患者生存期为3～32个月，平均（11．57±5．47）个月。胃癌所致肠梗阻疗效及预后均较差。9例肠梗阻无明显缓解者给予对症治疗或手术治疗。结论区域性动脉灌注化疗及栓塞对不能手术恶性肠梗阻具有较高的肠梗阻缓解率。选择性直肠动脉灌注化疗及栓塞对缓解结直肠癌及盆腔转移瘤所致肠梗阻症状安全、可行。

Objective To evaluate the clinical application of regional arterial infusion chemotherapy together with embolization in treating inoperable malignant bowel obstruction （MBO）. Methods The clinical data of 86 patients with inoperable MBO, who received regional arterial infusion chemotherapy and embolization, were retrospectively analyzed. The response rate and effective duration were calculated. The disease-free survival time and overall survival time of different tumors that caused MBO were compared. Results Continuous infusion chemotherapy via superior mesenteric artery was performed in 35 patients, continuous infusion chemotherapy via inferior mesenteric artery together with embolization was employed in 51 patients, and additional bilateral internal iliac artery infusion chemotherapy was carried out in 16 patients. Continuous infusion chemotherapy via both superior and inferior mesenteric artery was adopted in 7 patients. The patients received 1-8 times of infusion chemotherapy and embolization, with a mean of 3.62 times. The bowel obstruction began to ease within 4-156 hours （mean 22.5 hours） after initial treatment. The response rate was 89.5% （77/86）. The sustained remission time of intestinal obstruction was 2-16 months, with a mean of （7.03±3.02） months. From the onset of intestinal obstruction, the patients＇ survival time was 3-32 months, with a mean of （11.57±5.47） months. The response and prognosis of MBO caused by gastric cancer were worse than those caused by colorectal cancer and ovarian cancer. Symptomatic treatment or surgical treatment was adopted in 9 patients who showed no obvious remission of intestinal obstruction after regional arterial infusionchemotherapy and embolization. Conclusion For the treatment of inoperable MBO, regional arterial infusion chemotherapy together with embolization can effectively relieve the intestinal obstruction. Selective rectal arterial infusion chemotherapy and embolization is safe and feasible in relieving the symptoms of intestinal obstruction caused by colorectal carcinoma and pelvic metastasis.