经动脉药盒输注吉西他滨治疗37例晚期胰腺癌

Clinical value of infusion gemcitabine via artery port and catheter system for 37 cases with ad-vanced panceratic cancer

目的:评价经动脉药盒输注吉西他滨对未经其他治疗的晚期胰腺癌的疗效。方法:57例均经手术探查未能切除并经病理证实为胰腺癌患者,采用介入的方法植入德国贝朗公司的Implantofix药盒,9例经左锁骨下动脉将药盒植入于左胸壁皮下,48例经右股动脉将药盒植入于右下腹股沟部。治疗组首次疗程总量分3次注入吉西他滨3.0 g,氟尿嘧啶3.0 g,白细胞介素-2 600万U。对照组仅不输注吉西他滨。结果:57例介入药盒均植入成功,留置管通畅率达100%,留置管滑脱率为0%,2例老年肥胖女性患者右腹股沟部切口愈合不良而于术后2个月拔除药盒。57例按照胰腺癌患者临床受益反应的评价标准,分为治疗组(37例)、对照组(20例)。本研究主要疗效评估指标(临床受益反应)治疗组比对照组有效。27.2%的治疗组患者获疼痛程度、止痛剂用量的显著而持久的改善,而对照组为4.8%(P=0.0022)。临床受益反应持续时间治疗组18周,对照组13周。治疗组的中位生存期6.25个月,对照组为4.41个月,具有统计学意义(P=0.0025)。治疗组6个月、9个月及12个月的生存率分别为46%、24%和18%,高于对照组的31%、6%和2%。结论:经动脉药盒输注吉西他滨对晚期胰腺癌有明显的缓解疼痛、延长生存期的作用,并为晚期患者提供了长期动脉内化疗灌注的良好、有效的途径。

Purpose:To investigate the efficacy of infusion gemcitabine via artery port and catheter system (PCS) for advanced pancreatic cancer.Methods:57 cases advanced pancreatic cancer proved by pathology were implanted Implantofix PCS.The number of ports implanted subcutaneously in inferior right abdomen and subcutanceusly in inferior chest was 48 and 9 cases respectively.The first total does in experience group was gemcitabine 3.0,5-FU 3.0,IL-2 6 million u via three times infusion.Results:The overall implanted successful rates was 100% and indwelling catheter tip dislocation rate was 0. Two PCS were pulled out in 2 fat old female patients because of bad wound healing after two months.In the experimental and control group according to the standard of clinical benefit-responces were 37 and 20 respectively.The obvious improve- ment in pain in experimental and control group was 27.2% and 4.8%,respectively.The duration of clinical benefit-re- sponces were 18 weeks in experimental groups,13 weeks in control group.The midian survival in experimental group was 6.25 months,4.41 months in control group.The 6-,9-,12-months survival rates in experimental group were 46%,24%, 18% more thans 31%,6% and 2% in control group.Conclusions:Infusion gemcitabine via artery PCS can not only relieve pain,prolong survival rate but also provides a long-term intra-arterial chemotherapy and effctive access for advanced pancre- atic cancer.