Objective To observe the drug distributional characteristics after regional arterial perfusion chemotherapy (RAC) during gastric cancer radical resection, postoperative histopathological change and clinical toxic and adverse reactions. Methods According to the indications of RAC, 60 patients admitted in this department from September 2007 to November 2008 were included and divided into treated group and control group randomly. Treated group underwent the treatment of RAC with the 100 ml perfusion fluid including 5-FU (1 000 mg/m2), MMC (10 mg/m2) and 2 ml methylene blue injection by which the control group were not treated. Then the methylene blue distributional characteristics during operation, postoperative histopathological changes of tumors and clinical toxic and adverse reactions were observed. Results In the treated group, after RAC with injection contained methylene blue by primary supply arterial, the tumor region colored immediately and then dropped slowly, but it presented blue during whole operation. After operation, light microscope examination revealed a mild change of karyopyknosis, nuclear swelling, coagulation of cytoplasm in cancer cells, mild hydropsia of intercellular substance, invasion of inflammatory cells and mild vasculitis in some cases. Transmission electron microscope showed that nuclear swelling or coagulation, nuclear heterochromatin agglutination, nuclear-week gap expansion, mitochondrial swelling, endoplasmic reticulum expansion, and Golgi complex expansion. AST of treated group increased apparently on the first day (Plt;0.01), and recovered normal on the third day (Pgt;0.05). There was no significant difference between the two groups in renal function, ALT, ALP, GGT, LDH of liver function, medullary restraining, ECG by bed or reaction of gastrointestinal tract (Pgt;0.05). And stomal leak was not found in two groups. Conclusions The RAC during radical resection of gastric cancer enables gastric tumor to expose to therapeutics during whole operation and depresses the activity of cancer cells. Its clinical toxicity is little, so it can be used as an important supplementary means to prevent intraoperational extension and postoperative recurrence.
目的 评价术前立体超选择性动脉灌注化疗在ⅡB～ⅢA期乳腺癌保留乳房手术中的价值。方法 36例乳腺癌患者，其中ⅡB期10例、ⅢA期26，术前采用立体超选择性动脉灌注丝裂霉素、表阿霉素和5-氟尿嘧啶，化疗后再进行手术。结果 36例患者灌注化疗后病灶缓解32例，好转3例，无明显变化1例; 缓解率达88.9%（32/36），该32例患者肿瘤直径均缩小到2 cm以下，获得保乳手术机会。结论 术前立体超选择性动脉灌注化疗可使局部晚期乳腺癌降期获得保乳机会。
ObjectiveTo evaluate the effect of preoperative regional intraarterial infusion chemotherapy on the prognosis of advanced gastric cancer. MethodsThe clinical data of 80 patients who underwent curative resection for advanced gastric cancers were summarized.Among them,33 patients carried out preoperative regional intraarterial infusion chemotherapy were as the interventional chemotherapy group,and the remaining 47 patients were the control group.Eleven factors including clinical and pathological data,treatment procedures and molecular biological makers that contributed to the longterm survival rate were analyzed by Cox multivariate regression analysis.ResultsThe 5year survival rate of the interventional group was 59.3%,and the control group 47.6%.There was significant difference between two groups (P＜0.05).Multivariate regression analysis revealed that the preoperative regional intraarterial infusion chemotherapy was one of the independent factors affecting the longterm survival of patients with advanced gastric cancers.ConclusionThe preoperative regional intraarterial infusion chemotherapy has important value for improving the prognosis of gastric cancer.
Objective To evaluate the legitimate of regional artery infusion chemotherapy in the treatment of gastric carcinoma. MethodsThe pharmacokinetics of 5-Fu after different route of administration was studied. Results High concentration of 5-Fu found in portal vein via left-gastric intra-artetial administration were 4-40 folds higher than the group via intravenous administration.The time of high concentrations of 5-Fu via left-gastric intra-arterial administration maintained significantly longer than by intravenous administraion. The concentration of 5-Fu in tumor tissues and paratumorous lymph tissues by intra-arterial administration were 19 times and 23 times of the group by intravenous administration. Conclusion Regional arterial infusion chemotherapy can significantly increase the concentration of chemotherapeutic drugs in the tumorous region.
Objective To explore the feasibility, safety, efficacy and mechanism of intraoperative regional chemotherapy of advanced gastric cancer.Methods The related literatures were reviewed and analyzed. Results Compared with systemic chemotherapy, intraoperative regional chemotherapy of advanced gastric cancer could increase blood drug concentration of cancerous tissue, reduce the systemic toxic side effects, increase survival rate and improve the quality of life. Conclusion Intraoperative regional chemotherapy, as an adjuvant treatment of advanced gastric cancer, has been gradually applied to clinic because of the definite curative effect, which is worth popularizing. However, it needs systemic researches and accumulation of cases.
【摘要】目的 观察介入灌注化疗栓塞后手术切除直肠癌的临床疗效。方法 本组31例患者于术前先行区域性动脉灌注化疗加栓塞术，然后多在3～7 d内限期行直肠癌根治术，其中行Dixon术23例， Miles术7例， Hartmann术1例。结果 本组患者术中出血少，肿瘤剥离容易，一般无须输血； 患者术后的肿瘤复发率、转移率和死亡率均优于我科同期术前未行区域性动脉灌注化疗加栓塞术而直接接受手术治疗者。结论 先行区域性动脉灌注化疗栓塞术后再行直肠癌根治性切除，近期疗效好，不失为直肠癌综合治疗的一种新的有效方法。
ObjectiveTo summarize the research progress of preoperative regional-arterial chemotherapy in advanced gastric cancer. MethodThe literatures about the research progress of preoperative regional-arterial chemotherapy in the advanced gastric cancer were reviewed. ResultsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer could decrease the tumour stage, improve the R0 resection rate and the long-term survival rate, effectively improve the drug concentrations of tumor and portal vein, and not only kill or damage cancer cells directly, but also prevent the metastasis of liver and lymph nodes effectively, and reduce the side effects, cause the nuclear pyknosis and fracture of cancer cells in a short time. The course of preoperative regional-arterial chemotherapy in the advanced gastric cancer generally was 4-9 weeks, and then whether the surgery treatment was decided to undergo according to the results of the curative effect evaluation. ConclusionsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer has more advantages than intravenous chemotherapy, further research of multicenter and large clinical trials, would inaugurate a wider application prospects.
ObjectiveTo investigate the significance of apparent diffusion coefficient (ADC value) for pretrea-tment prediction of short-term treatment effect in patients with hepatocellular carcinoma (HCC) who underwent transca-theter arterial chemoembolization (TACE). MethodsA total of twelve HCC patients with twenty-three HCC lesions who underwent TACE in our hospital from May. 2014 to May. 2015 were enrolled prospectively, to explore the difference between pre-and post-TACE in diameter of tumor, ADC value of HCC lesions, ADC value of liver parenchyma, and analyze the predictive significance of ADC value of HCC lesions for TACE in treatment of HCC. ResultsThere were no statistical difference between pre-and post-TACE in diameter of HCC lesions and ADC value of liver parenchyma (P=0.635, P=0.473), but the ADC value of HCC lesions was higher after TACE than pre-TACE (P=0.003). After TACE, the area of necrosis in HCC lesions was≥50% in 17 lesions (73.9%, good effect group), and <50% in 6 lesions (26.1%, poor effect group). Compared with poor effect group, ADC values of HCC lesions in good effect group were both higher before and after TACE (P<0.050). Area under ROC curve (AUC value) of ADC value in HCC lesions before TACE for predicting the effect of TACE was 0.690 (95% CI:0.510-0.879), with the sensitivity and specificity of 82.3% (95% CI:65.5%-93.2%) and 53.8% (95% CI:25.1%-80.8%) respectively, and the demarcation point for good effect and poor effect was 1.24×103 mm2/s. ConclusionThis preliminary study demonstrates that the ADC value of HCC lesions before TACE may be a useful indicator to predict early response of TACE in treatment of HCC.