经导管动脉灌注化疗药物应用原则--中国肿瘤介入专家共识  

Chinese tumor intervention expert consensus on the application principles of transcatheter arterial infusion chemotherapy

作　　者：王革芳[1] 

机构地区：[1]解放军第八五医院

出　　处：《介入放射学杂志》2017年第11期963-970,共8页Journal of Interventional Radiology

摘　　要：经导管动脉灌注化疗(TAI)是肿瘤介入治疗的重要手段之一,也是保证化疗在局部治疗中发挥最大抗癌效力的一个必要途径。TAI中药物选择既要遵循常规全身化疗基本原则,又要兼顾经导管区域性药物灌注特性。理论上静脉输注化疗药物均能经动脉灌注,但需经人体转化后才能起效的药物不适用于TAI。TAI是在肿瘤供血动脉内直接灌注药物,能克服部分静脉化疗无法通过的生理屏障,起到药物"首过效应",从而显著提高肿瘤局部药物浓度,提高疗效。TAI后化疗药物同样会沿血液循环到全身,同时也起到全身化疗作用。TAI也会产生不良反应,相比全身化疗程度要轻微,对人体免疫功能损害亦较轻。TAI虽然适用于各种中晚期恶性肿瘤,但也必须严格把握适应证和禁忌证,即在选择用药时应谨慎、合理,争取在获得最大有效作用的同时减少不良反应。选择TAI药物时应根据以下用药原则:选择肿瘤敏感药物,选择原型起作用药物,首选浓度依赖型药物,联合应用不同作用机制药物,尽量避免药物毒性作用相同或对同一脏器毒性累加的药物,不得应用相互拮抗或相互发生不良化学反应的药物及溶剂配伍,严格执行特殊药物使用说明,给予适当剂量的化疗药物,注意化疗药物应用先后顺序,重视非抗肿瘤药物与化疗药之间相互作用,以及药物稀释浓度与容量。Transcatheter arterial infusion （TAI） chemotherapy has been one of the important means of tumor interventional therapy, and it is also a necessary way to ensure that chemotherapy can play a maximum anti-cancer effect for the local treatment of cancer. For the proper performance of TAI, the selection of drug should follow the basic principles of the conventional systemic chemotherapy, and also the transcatheter regional drug perfusion characteristics should be taken into consideration. Theoretically, all the chemotherapeutic drugs that can be used for intravenous infusion can be employed for arterial perfusion, i.e. suitable for TAI, except for the drugs that exert their effect only when they have been converted by the human body. The performance of TAI is to inject the chemotherapeutic drugs directly into the tumor-feeding arteries, thus, it can overcome the disadvantage that some chemotherapeutic drugs via intravenous route cannot pass through the physiological barrier. Besides, the ＂first pass effect＂ of the chemotherapeutic drugs can remarkably improve the local drug concentration of tumor and improve the curative effect. In TAI, the chemotherapeutic drugs can also go into the whole body tissue along with the blood circulation, playing the role of systemic chemotherapy. TAI will also produce adverse reactions, although these adverse reactions are much milder when compared to systemic chemotherapy. Although TAI is suitable for all kinds of advanced malignant tumors, its indications and contraindications must be strictly observed, which means that the selection of drugs should be careful and reasonable, so as to minimize the adverse effects and to achieve maximum effectiveness. The selection of drugs for TAI should be based on the following medication principles： using tumor sensitive drugs, selecting prototype drug with anti-cancer effects, preferring use of concentration-dependent drugs, combination use of drugs with different mechanisms, avoiding use of the drugs that have the same toxic effects or

关 键 词：恶性肿瘤 经导管动脉灌注化疗 化疗药物 

分 类 号：R730.5[医药卫生—肿瘤]