絲裂霉素纖維蛋白凝膠緩釋化療胃腸道低分化腺癌的臨床研究

1、絲裂霉素纖維蛋白凝膠緩釋化療胃腸道低分化腺癌的臨床研究         11-02-13 10:45:00     編輯：studa20                     作者：鄭武平，許榮華，高炳玉孟 津，夏立平，房學(xué)東 【摘要】  目的：本研究以絲裂

2、霉素纖維蛋白凝膠緩釋化療胃腸道低分化腺癌T4期殘留病灶,觀察腫瘤局部復(fù)發(fā)及淋巴轉(zhuǎn)移情況，并且了解局部化療對全身的影響。方法：術(shù)中制備絲裂霉素纖維蛋白凝膠噴涂在實驗組術(shù)者腹腔內(nèi)殘留病灶或瘤床周圍,并用標(biāo)記物標(biāo)記出殘留范圍或瘤床范圍,而對照組未使用。觀察兩組：(1)術(shù)后1 ，3 ，6 ，12 ，18個月,復(fù)查CT，了解腫瘤局部復(fù)發(fā)情況及淋巴轉(zhuǎn)移情況。(2)術(shù)后7 d內(nèi)復(fù)查血常規(guī)、尿常規(guī)、肝腎功能、電解質(zhì),并且觀察術(shù)后的患者的化療不良反應(yīng)及病情變化，了解局部化療對全身的影響。結(jié)果：試驗組局部標(biāo)記病灶6個月進(jìn)展者1例，12個月進(jìn)展者3例，18個月進(jìn)展者5例，隨診18個月15例患者局部標(biāo)記范圍病灶無進(jìn)展

3、;對照組局部標(biāo)記病灶3個月進(jìn)展者1例，6個月進(jìn)展者3例，12個月進(jìn)展者7例，18個月進(jìn)展者13例，隨診18個月7例患者復(fù)查局部腫瘤無進(jìn)展。術(shù)后7 d所有病例均未觀察到出現(xiàn)化療不良反應(yīng)。隨診18個月對照組和實驗組的局部病灶情況比較差異有統(tǒng)計學(xué)意義(P<0.01)。結(jié)論：絲裂霉素纖維蛋白凝膠緩釋化療對T4期的胃腸道低分化腺癌術(shù)中局部殘留的病灶有抑制作用，并且全身毒副反應(yīng)輕微。 【關(guān)鍵詞】  絲裂霉素纖維蛋白凝膠;緩釋化療;胃腸道低分化腺癌;術(shù)中殘留           &#

4、160;  Sustainedrelease chemotherapy with mitomycin fibrin gel for gastrointestinal poorly differentiated adenocarcinomaZHENG Wuping1, XU Ronghua1, GAO Bingyu1, MENG Jin1, XIA Liping1, FANG Xuedong2(1.Affiliated Hospital of Hainan Medical College; Tumor Research Institute, Haikou 570102, China;

5、2.The Second Hospital, Normal Bethune College of Medicine, Jilin University, Changchun 130021, ChinaABSTRACT Objective: To evaluate the effects of sustainedrelease chemotherapy using fibrin glue enwrapping mitomycin (MMC/FG) for gastrointestinal poorly differentiated adenocarcinoma. Methods: All pat

6、ients with gastrointestinal poorly differentiated adenocarcinoma after surgical resection of the primary tumor were randomly treated with (experimental group) or without (control group) MMC/FG. For the experimental group, MMC/FG was sprayed onto the residual tumor or around the base of the removed t

7、umor. The residual area or bed of the removed tumor were marked for observation. Inspect local tumor recurrence and lymphatic metastasis by CT scan 1, 3, 6, 12 and 18 months after chemotherapy; observe side reactions and the general condition of the patients; implement routine blood and urine test,

8、liver and kidney function examination 7 days after the treatment. Results: 6, 12 and 18 months later, there were 1, 3 and 5 cases in the experimental group were evaluated as progression disease respectively, while 1, 3, 7 and 13 cases in the control group were evaluated as regression disease 3, 6, 1

9、2, and 18 months after surgery. According to the 18 months follow up, 15 and 7 cases of the experimental and control group showed no progression, there were significant differences between the observed local lesions of these two groups. There were no severe chemotherapy side reactions being observed

10、 7 days after the surgery. Conclusion: Sustainedrelease chemotherapy using fibrin glue enwrapping mitomycin(MMC/FG) have inhibitory effects on localized residual of gastrointestinal poorly differentiated adenocarcinoma with edurable toxicity.KEY WORDS Fibrin glue enwrapping mitomycin; Sustainedrelea

11、se chemotherapy; Local residual; Gastrointestinal poorly differentiated adenocarcinoma胃腸道癌發(fā)病率占消化道腫瘤絕大部分,外科根治性切除是目前唯一可能治愈的手段1。由于大部分患者就診時已屬中晚期,失去了手術(shù)根治機會,因而化療是改善患者生活質(zhì)量、延長生存期的主要手段之一。但由于全身化療到達(dá)腫瘤局部的藥物有效濃度低，且多數(shù)化療藥物都存在明顯的療效-劑量依賴關(guān)系，即加大藥物劑量能明顯提高療效，但勢必增加全身的毒副反應(yīng)，使化療藥物的臨床應(yīng)用受到很大的限制。因此，提高化療藥物的局部藥物濃度，減少全身的毒副反應(yīng)一直是腫瘤

12、治療的重要研究課題。目前，以生物蛋白膠為載體緩釋化療多數(shù)尚處于實驗階段，應(yīng)用于腦膠質(zhì)瘤報道相對較多2-6，應(yīng)用在消化道腫瘤方面罕見報道7。同時，胃腸道癌細(xì)胞腹腔內(nèi)播散占胃癌、結(jié)腸癌患者死亡原因的50%左右，與單純根治性手術(shù)相比,術(shù)后輔助腹腔內(nèi)化療可以明顯預(yù)防和延緩腫瘤的局部復(fù)發(fā)8。本文通過前瞻性隨機入組的試驗對照方法，研究了絲裂霉素纖維蛋白凝膠緩釋化療術(shù)中局部有殘留病灶的胃腸道低分化腺癌，并對研究資料進(jìn)行了綜合的分析。1 資料與方法1.1 一般資料1.1.1 入組標(biāo)準(zhǔn) (1)術(shù)前胃鏡或結(jié)腸鏡檢查及病理檢查明確診斷為低分化腺癌;(2)術(shù)前經(jīng)CT或B超檢查提示有漿膜局部外侵，即T4病灶;(3)術(shù)前無主要臟器功能障礙，血常規(guī)、肝功能、腎功能、電解質(zhì)及心肺功能無明顯異常;(4)患者有良好的依從性，能接受術(shù)后的治療及隨訪方式;(5)患者術(shù)前KPS評分70 min;鄭武平等.絲裂霉素纖維蛋白凝膠緩釋化療胃腸道低分化腺癌的臨床研究 (6)術(shù)中探查發(fā)現(xiàn)腫物侵犯周圍組織、臟器的漿膜面，手術(shù)不能達(dá)到R0切除。1.1.2 排除標(biāo)準(zhǔn) (1)術(shù)前胃鏡或結(jié)腸鏡檢查及病理檢查不符合入組標(biāo)準(zhǔn)的病理組織學(xué)類型;(2)術(shù)前經(jīng)B超及