直肠粘膜下植入5-FU缓释剂在直肠癌化疗中的应用

Evaluation of chemotherapy with rectal submucosal implant of 5-FU SRI in the patients with rectal cancer.

目的 研究直肠癌病人术前直肠粘膜下植入 5 -FU缓释剂后 ,癌组织病理形态学、癌细胞凋亡和增殖的变化。方法 对 2 5例直肠癌拟手术者采用配对设计分为两组 :Ⅰ组 (n =13)为植药组 ,每例术前直肠粘膜下植入 5 -FU缓释剂 5 0 0mg。Ⅱ组 (n =12 )为非植药组 ,采用常规术前准备。两组病人均在术前 (植药前 )及术后立即取肿瘤组织。观察癌组织病理形态和识别凋亡癌细胞、增殖细胞核抗原表达的变化。数据采用SPSS10 1软件进行统计学处理。结果 Ⅰ组中癌组织出现化疗效应的病理形态学改变 ;癌细胞凋亡指数 (AI)化疗后(3 6 2 3± 1 2 35 )较化疗前 (1 2 0 0± 0 398)明显增加 ,P <0 0 5 ;癌细胞的增殖指数 (PI)化疗后 (46 6 2± 7 2 2 )较化疗前 (5 6 85± 6 4 8)明显降低 ,P <0 0 1。而Ⅱ组手术前后病理形态学无变化 ,癌细胞AI、PI无明显改变。全组未发现毒副作用。结论 直肠粘膜下植入 5 -FU缓释剂是直肠癌术前区域性化疗的最佳途径之一 。

Objective\ To evaluate the effect of a neoadjuvant chemotherapy with 5-Fluorouracil sustained release for implant(5-FU SRI)injected in rectal submucosal in the patients with rectal cancer.The effect of this treatment was judged by cellular degeneration,necrosis degree,apoptotic index(AI),the positive rate of proliferating cell nuclear antigen(PCNA)expression(PI).Methods\ Twenty-five patients with rectal cancer were divided into two groups.In group Ⅰ(n=13),patients underwent the treatment of submucosal multiple 5-FU SRI with the simple dose of 500mg/body 72 hours before operation.In group Ⅱ(n=12),patients did not receive any chemotherapy before operation.Tumor pathologic examination was done before 5-FU SRI injected and after tumor removed.Apoptotic cells were identified.The expression of PCNA was examined by immunohistochemical staining.The program of SPSS(10 1)was used.Results\ In group Ⅰ,the cellular degeneration and necrosis due to the chemotherapy was found.Post-chemotherapy AI(3 623±1 235)was higher than that before(1 200±0 398),P<0 05,and post-chemotherapy PI(46±7 22)was lower than before(56 85±6 48),P<0 01 No side effect was found in all patients.Conclusion\ The treatment of rectal submucosal multiple implant of 5-FU SRI presents a significant pharmcokinetics advantage and reasonability in preventing post-operative recurrence and metastasis of rectal cancer.