选择性动脉药物灌注治疗直肠癌疗效观察.doc

???? 选择性动脉药物灌注治疗直肠癌疗效观察 ???? ????摘　要　目的：探讨选择性运脉药物灌注在治疗直肠癌中的临床疗效和不良反应。方法：对48例直肠癌行选择性肠系膜下动脉或/和骼内动脉灌注化疗。结果：①CR0%，PR35.4%，MR52.1%，有效率35.4%；②40例行2期手术，术中见病灶周围明显纤维化，术后病理证实病灶周围炎性细胞浸润和纤维组织增生。③骨髓抑制、胃肠道反应明显，对心脏、肝脏、免疫系统也有一定影响。④并发症：2例发生完全肠梗阻，1例左半结肠坏死。结论：于直肠癌手术切除前先行选择性动脉药物灌注化疗，可使肿瘤缩小，并刺激瘤周炎性反应和纤维组织增生，从而提高手术切除率，降低术后局部复发和远处转移可能，该方法有一定的毒副反应和发生肠梗阻、肠坏死的潜在危险。　　关键词　直肠癌；选择性；动脉；灌注化疗；毒副反应 Observation on Therapeutic Effect in the Treatment ofRectal Cancer with Selective Arterial Drug Perfusion Zheng Qubin,Yang Weizhu,Jiang Na,et al 　　Dept.of Intervene,Union Hospital,Fujian Medical University,Fujian 350001 　　Objection:The present paper is to explore the clinical value and ill reaction to selective arterial drug perfusion on rectal cancer.Method:chemotherapy of selective arterial perfusion was use in the treatment of 48 cases of rectal cancer in their inferior mesenteric internal iliae artery.Results:(1) CR 0%,PR 35.4%,MR 52.1%,effective rate 35.4%.(2) 40 cases show obvious focus fibrosis at 2nd stage operation.Postoperative pathological analysis conformed a widespread inflammatory cell infiltration and fibroplastic proliferation.(3) An apparent arrest in the foundation of bone marrowand obvious toxic side reaction in gastrointestinal tractwere found.Also,there was some influence on the liver,heart and immune system.(4)Complications:After operation peritonitis appeared in 5cases,among which were 2of intestinal obstruction,and 1 necrosis of left hemicolon.Conclusion:The chemotherapy of selective arterial drug perfusion before an operation reduce the tumor and stiumulate inflammatory reaction and fibroplastic proliferation around it.Thus increases excision rate as well as decreases local recurrence rate and possiblity of cancer merastasis.However,it also leads to some toxic side reaction and possible intestinal obstruction and necrosis.　　Key words:Chemotherapy;selection;Arterial Drug perfusion;Observation;Therapeutic effect;Rectal cancer 　　我院自1993年到1997年，采用经皮穿刺肠系膜下动脉或/和骼内动脉，行化疗药物灌注治疗48例直