胃癌病人术前选择性动脉栓塞化疗对肿瘤血管的影响  

Effects of preoperative selective gastric arterial chemoembolization on the tumor vasculature in patients with gastric carcinoma

作　　者：孙碎康[1] 蒲青凡[1] 严律南[2] 潘继豹[1] 曹高健[1] 吴文珍[1] 

机构地区：[1]温州医学院附属第三医院普外科,浙江瑞安325200 [2]四川大学华西医院普外科,四川成都610041

出　　处：《中国普通外科杂志》2002年第4期202-204,共3页China Journal of General Surgery

摘　　要：目的　探讨胃癌术前选择性动脉栓塞化疗对肿瘤血管的影响。方法　 40例胃癌患者分为灌注化疗组 (GAI)和栓塞化疗组 (GAE )。两组于介入治疗前、治疗后 1,3d测定周围静脉及术中胃静脉血肿瘤坏死因子 α(TNF α)和血栓调节蛋白 (TM )浓度。治疗后 7～ 10d行胃癌根治术。观察胃组织病理学改变。结果　与GAI组比较 ,GAE组各时点周围静脉和胃静脉血TNF浓度明显增高 (P <0 .0 5 ) ,胃静脉血TM浓度明显降低 (P <0 .0 5 ) ,并与胃静脉血TNF水平呈负相关关系 (r =-0 .77,P <0 .0 5 )。组织学检查发现GAE组胃癌细胞及胃脂肪淋巴组织中癌细胞变性坏死明显 ,肿瘤血管炎症、内膜增厚、毛细血管血栓形成。结论　胃癌术前选择性动脉栓塞化疗 ,可能是通过TNF介导的肿瘤血管内皮损伤及血管内凝血 。Objective To investigate the effects of preoperative selective gastric arterial chemoembolization on the tumor vasculature in patients with gastric carcinoma.Methods 40 patients with gastric cancer were divided into two groups :(1)gastric arterial influsion(GAI)group;and (2)gastric arterial chemoembolization(GAE)group.The peripheral vein plasma tumor necrosis factor(TNF α) and thrombomodulin(TM)were determined before radiologic intervention(RI),and1d,3d after R1;and the gastric vein plasma TNF α and TM were also determined during operation.The curative surgical resection of gastric cancer was performed between 7 and 10 days after treatment.Stomach histological alterations were observed postoperatively.Results Compared with GAI group ,the plasma TNF α levels increased markedly at all the time points,and gastric vein plasma TM levels decreased siginificantly in GAE group (P<0.05).There was a negative correlation between gastric vein plasma TNF α and TM levels(r=-0.77,P<0.05).Perigastric and gastric tumor cells necrosis,vascular inflammation,endothelial edema ,intravascular coagulations were observed in GAE group.Conclusions Preoperative selective gastric arterical chemoembolization might induce tumor necrosis by TNF-mediated tumor vascular endothelial damage and intravascular coagulation in patients with gastric cancer.

关 键 词：胃癌病人 术前选择性动脉栓塞化疗 肿瘤血管 影响 

分 类 号：R735.205[医药卫生—肿瘤]