术前经动脉化疗在胃癌综合治疗中的应用  

Effects of preoperative regional arterial infusion chemotherapy on cancer cells and immune function in patients with gastric cancer

作　　者：卞育海[1] 陈治平[1] 庄捷[1] 凌伟[1] 倪醒之[1] 金云法[1] 

机构地区：[1]上海第二医科大学附属仁济医院普外科,200001

出　　处：《消化外科》2002年第5期337-339,共3页Journal of Digestive Surgery

摘　　要：目的 探讨术前经动脉化疗对胃癌患者肿瘤细胞和免疫功能的影响。方法20例进展期胃癌患者于术前行区域动脉化疗,并与同期20例患者行单纯手术作对照。观察化疗对术后恢复和外周血T细胞亚群及NK活性的影响。术后标本进行病理学检查,并以免疫组化法测定肿瘤增殖指标增殖细胞核抗原（PCNA）和Ki-67,以TUNEL法检测肿瘤细胞凋亡指数的变化。结果 术前区域动脉化疗,不会增加术后并发症。手术后,化疗组的总T细胞较对照组显著上升,而NK活性有所下降,且恢复较慢。化疗后65％的患者肿瘤组织出现癌细胞变性、组织坏死、纤维增生等病理改变。化疗组的增殖指数PCNA和Ki-67分别为（70.1±12.3）％和（28.9±6.8）％,较对照组的（81.3±7.3）％和（41.8±9.8）％显著下降（P<0.01）;而细胞凋亡指数则由对照组的（8.7±2.7）‰提高至化疗组的（12.7±6.2）‰（P<0.05）。结论 术前经动脉化疗能导致癌细胞变性坏死,并抑制肿瘤增殖,促进细胞凋亡。在围下术期对细胞免疫功能有一定影响。Objective To evaluate the effect of preoperative regional arterial infusion chemotherapy (RAIC) cancer cells and immune function in patients with gastric cancer. Methods Twenty patients with advanced gastric carcinoma received RAIC 5-9 days liefore operation, whereas other twenty, as controls, received operations only. The changes of T lymphocyte subsets and natural killer cell were observed of the patients' peripheral blood. Histopathological examination of their postoperative specimens were made to evaluate the therapeutic effect. For detection of proliferative cells, the expressions of PCNA and Ki - 67 were examined by immunohistochemica) staining, while the apoptotic indice was examined by TUNEL method. Results The total T cell count in the RAIC group elevated postoperatively, but the NK activity decreased remarkably after chemotherapy, and could not return to normal level in a short time after operation. In sixty- five percent of the patients in RAIC group degeneration of cancer cells, necrosis of tumor tissue, and fibrosis formation were found. The expression of PCNA and Ki - 67 were (70.1±12.3)% and (28.9±6. 8) % in the RAIC group, which decreased significantly compared with the controls [(81.3±7.3)% and (41.8±9.8)% respectively] ( P < 0.01) , while the apoptotic index increased inversely (12.7±6.2)%c compared with (8.7±2.7)%cin the control ( P < 0.05). Conclusions Preoperative regional arterial infusion chemotherapy to gastric cancer may cause necrosis and degeneration of tumor cells, inhibit proliferation and enhance apoptosis. Meanwhile, it might influence the cellular immune function.

关 键 词：胃癌 区域动脉灌注化疗 免疫组织化学 细胞凋亡 T淋巴细胞 治疗 

分 类 号：R735.2[医药卫生—肿瘤]