结直肠癌术前区域动脉灌注化疗疗效的组织学评价  

Histological evaluation on preoperative regional intraarterial chemotherapy for colorectal carcinoma

作　　者：夏泽锋[1] 袁野[1] 陶凯雄[1] 韩高雄[1] 帅晓明[1] 蔡开琳[1] 王继亮[1] 杜寒松[1] 邓美洲[1] 王国斌[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院腹腔镜外科,武汉430022

出　　处：《中华普通外科杂志》2010年第5期353-356,共4页Chinese Journal of General Surgery

基　　金：湖北省研究与开发计划项目（2008BCC006）;湖北省医学临床研究中心项目（JX4D07、JX4D08）;湖北省科技攻关计划项目（2005AA304B09）

摘　　要：目的 评估腹腔镜结直肠癌手术联合术前区域动脉灌注化疗的组织学疗效及其临床应用价值.方法 对23例结、直肠癌患者于术前应用Seldinger技术行区域动脉造影并行选择性动脉灌注化疗,针对直肠癌以及肝转移的患者同时行碘油栓塞,1-11 d后行腹腔镜手术,标本行病理组织学检测.参照化疗组织学疗效评定标准评级,分析其与肿瘤分化程度、TNM分期之间的联系,比较术前区域动脉灌注化疗与术前区域动脉灌注化疗联合栓塞的组织学疗效差异.应用χ2检验组内差异.结果 经术前动脉灌注化疗的23例患者其肿瘤组织学疗效0级2例,Ⅰ级7例,Ⅱ级10例,Ⅲ级4例,总有效率为91%（21/23）,在15例有淋巴结转移的患者中有效率为87%（13/15）.肿瘤分化程度、TNM分期与组织学疗效无明显相关性.术前介入化疗联合栓塞较单独应用化疗疗效有显著性优势.结论 对不同分化程度、不同TNM分期的结直肠癌患者,术前选择性区域动脉灌注化疗均有良好的组织学疗效,直肠癌患者联合栓塞治疗可进一步提高疗效.Objective To evaluate the histological response and the clinical value in laparescopic colorectal surgery combined with preoperative regional intra-arterial chemotherapy（PRAC）. Methods In cases of rectal cancer and fiver metastases selective regional intra-arterial chemotherapy and iodinated oil embolism was carried out in 23 cases of colorectal carcinoma. After 1 to 11 days laparoseopic radical resection was done, specimens were sent for histopathological examination. We analyzed the correlation between tumor differentiation and TNM stage, compared the effect of PRAC with PRAC ＋ embolism by the criteria of histological response of chemotherapy. χ2-test was used to compare interclass correlation.Results The histological effect in the 23 cases of PRAC level 0 was in 2 cases, level Ⅰ in 7 cases, level Ⅱ in 10 cases, and level Ⅲ in 2 cases. The overall effective rate was 91% （21/23）. In the 15 cases with lymph node metastases, the effective rate was 87% （13/15）. There was no significant statistic correlation between tumor differentiation or TNM stage and histological response. PRAC associated embolism had a better histological response compared to PRAC alone. Conclusions Preoperative regional intra-arterial chemotherapy had marked therapeutic effect on histological response to the colorectal carcinoma patients of various tumor differentiations and TNM stage, especially combining with the embolism to rectal cancer could improve the efficacy.

关 键 词：结直肠肿瘤 化学疗法 肿瘤 局部灌注 组织学 

分 类 号：R735.3[医药卫生—肿瘤]