介入联合手术综合治疗大肠癌的临床应用

Clinical evaluation of preoperative arterial infusion chemotherapy and surgical operation for colorectal carci-noma

目的 评价术前介入化疗和手术对大肠癌的治疗价值。方法 66例大肠癌术前经导管动脉内联合抗癌药物灌注治疗,治疗后5～30d(平均12d)手术切除肿瘤。其中50例切除标本作了组织学疗效和细胞凋亡观察,以介入治疗前22例肠镜活检标本和25例正常肠黏膜(标本正常肠切缘)作对照。结果 肿瘤组织学疗效Ⅰ级20例,Ⅱ级21例,Ⅲ级9例。肿瘤凋亡细胞密度介入化疗前为31.47±5.58,介入化疗后为76.69±17.12,正常肠黏膜为8.01±3.39。介入治疗后凋亡细胞密度明显高于介入治疗前(P<0.001),腺癌明显高于正常肠黏膜(P<0.001)。不同病理分期肿瘤的组织学疗效之间差异无显著性(P>0.30)。不同病理分期肿瘤的细胞凋亡也无差异(P>0.05)。1、3和5年生存率分别为95.1％、71.1％和48.5％。介入治疗后66例中手术根治58例,根治率为87.9％。结论 大肠癌术前经导管动脉灌注化疗,肿瘤组织学疗效显著,肿瘤细胞凋亡明显。

Objective To investigate the clinical values of preoperative arterial infusion chemotherapy and surgical operation for coloreclal carcinoma. Methods 66 patients with colorectal carcinoma were subjected to percutaneous femoral artery catheterization by Seldinger's technique with infusion of anti-cancer durgs. The resection was performed 5-30 days after the arterial infusion (mean 12 days). In 50 surgical specimens of the 66 cases, histological findings were evaluated including the density and distribution of the apoptosis cells under the observation by DNA nick end labelling technique. Of which 22 specimens before arterial infusion chemotherapy (got from biopsy of preoperation) and 25 normal mucosa (gol form normal surgical specimens) were used as controls. Results The total histological response rate was 100% with grade Ⅰ in 20 cases, grade Ⅱ in 21 cases, grade Ⅲ in 9 cases. The densities of the apoptosis cells were 31. 47±5. 58 before arterial infusion chemotherapy, 76. 69±17. 12 after arterial infusion chemotherapy and 8.±3.39 in normal mucosa. The density of the apoptosis cells after arterial infusion chemotherapy was significantly higher than that before arterial infusion chemotherapy (P<0. 001) and the density of the apoptosis cells in adenocarcinoma was significantly higher than that in normal mucosa (P<0.001). The radical operation rate reached 87.9%(58/ 66). The 1-, 3-, and 5-year survival rates were 95. 1% , 71. 1 % , and 48.5% , respectively. The histological response in different pathological stages showed no significant differences (x2 =4.696, P>0.30). There were no significant differences in the apoptosis of adenocarnoma during different pathological stages (F = 0. 001376, P>0.05). Conclusions Peroperative transcatheter arterial infusion chemotherapy resulting in apoptosis of adenocarnoma, can raise the radical operation rate, and prolong survival rate for colprectal carcinoma patients.