选择性动脉灌注化疗在直肠癌术后盆腔复发再治疗的应用

Application of selective intra-arterial infusion chemotherapy for pelvic recurrence of rectal cancer

目的评价选择性动脉灌注化疗对于直肠癌手术后盆腔复发患者的疗效。方法104例患者随机分为两组,动脉灌注组(57例)采用FAM化疗方案(氟尿嘧啶500～750mg/m2,丝裂霉素15mg/m2,阿霉素40mg/m2)作髂内动脉灌注化疗后再接受手术;直接择期手术组47例。对比两组再次手术的成功率、标本病理变化特征和5年生存率。结果再手术成功率:动脉灌注组87.7%,直接择期手术组59.5%,两组比较,差异有显著性意义(P<0.001)。5年生存率:动脉灌注组40.3%,直接择期手术组14.9%,两组比较,差异有显著性意义(P<0.05)。动脉灌注组手术切除标本其病理特征主要表现为癌细胞固缩、凋亡、坏死,组织水肿减轻和供应血管栓塞;直接择期手术组手术标本则无特异性改变。结论对直肠癌术后盆腔复发的患者予以选择性动脉灌注化疗后再手术,能提高手术切除率、延长生存期。

Objective To evaluate the therapeutic effect of selective intra artcrial infusion chemotherapy in the patients with pelvic recurrence of rectal cancer. Methods All patients were divided in two groups: the neoadjuvant group(57 cases) received preoperative FAM chemotherapy, and the control group(47 cases) received only operation. The resection rate, 5 years survival rate and pathological findings were compared between the two groups. Results The resection rate of chemotherapy and control groups were 87.7%and 59.5%(P=0.001)and the 5 year survival rates were 40.3%and 14.9%respectively(P=0.012). Postoperative pathological findings revealed contraction, apoptosis and necrosis of cancer cells, vascular embolism and alleviated tissue edema in chemotherapy group, while no such changes in the control group. Conclusions Neoadjuvant therapy of selective intra arterial infusion chemotherapy can raise the resection rate and improve the survival of the patients with pelvic recurrence of rectal cancer.