术前淋巴化疗对乳腺癌的临床治疗研究  

Preoperative Lymphangial Chemotherapy on Breast Carcinoma

作　　者：李义生[1] 王书奎[2] 吕进[1] 王和明[1] 黄水清[1] 纪律[1] 

机构地区：[1]南京医科大学附属南京第一医院肿瘤外科,江苏南京210006 [2]南京医科大学附属南京第一医院检验中心,江苏南京210006

出　　处：《中国现代医生》2011年第30期28-29,32,共3页China Modern Doctor

摘　　要：目的探讨术前行淋巴化疗(lymphangial chemotherapy LC)对乳腺癌淋巴转移灶的治疗及预后影响。方法乳腺癌患者60例,随机分成两组各30例。实验组术前24h在肿瘤周围或瘤床皮下多点多方向注射表柔比星-活性炭混悬液(carbon activated absorbing epirubicin,Epi-CH)进行LC。对照组术前同时间静脉注射表柔比星水溶液行静脉化疗(intravenous chemotherapy VC)。在常规改良根治术清扫区域淋巴结后,用原子吸收光谱法检测两组患者淋巴结内表柔比星药浓度,用流式细胞术分别检测两组治疗后转移淋巴结的SPF(S期细胞比例)、APO(细胞凋亡)发生率及BCL-2表达。两组患者术后其他治疗方案无显著性差异。随访两组3、5年局部复发率及生存率。结果淋巴化疗后,LC组淋巴结内表柔比星药浓度明显高于对照组(P<0.01);LC组术后阳性淋巴结其S期细胞比例(SPF)、细胞凋亡(APO)发生率及BCL-2表达与VC组之间的差异有高度显著性(P<0.01);两组3年及5年局部复发率之间的差异有高度显著性(P<0.01)。两者术后并发症如皮下积液、切口皮瓣坏死等发生率的差异无统计学意义。结论相比于静脉化疗,术前LC能显著提高淋巴结内有效药浓度;能促进转移淋巴结癌细胞凋亡的发生;降低局部复发率,提高生存率。Objective To study the direct action of the lymphangial chemotherapy on lymph transferred cancer of the breast cancer. Methods Sixty patients with breast cancer, confirmed by preoperative puncture biopsy, were ramdomized into two groups. Group of LC： To inject the epirubicin absorbed by active carbon through the tissue around primary tumor 24 h before modified radical resection; group of VC ： inject the aqueous solution of the epirubicin through the intravenous. Then we examined the cancerous tissue by means of the flow cytometry and examined the concentration of epirubicin in nodes by Zeeman atomic absorption spectrometry.The relapse and metastatic rate and survival rate in 3 or 5 years were compared. Results There was a marked difference between the LC and VC in the concentration of epirubicin , the SPF, rate of APO, the expression of Bcl-2. There was significant difference in relapse and metastatic rate and survival rate between the two groups. Conclusion The LC can promote the apoptosis of the transferred cancer in the lymph system and improve the concentration of epiruhicin in nodes and improve the survival rate.

关 键 词：乳腺肿瘤 活性炭 淋巴化疗 细胞凋亡 

分 类 号：R737.9[医药卫生—肿瘤]