胃癌根治术中区域动脉灌注化疗的临床毒副反应及病理观察(PDF)
《中国普外基础与临床杂志》[ISSN:1007-9424/CN:51-1505/R]
- 期数:
- 2010年01期
- 页码:
- 17-21
- 栏目:
- 专题
- 出版日期:
- 2010-01-25
文章信息/Info
- Title:
- Clinical Toxic and Adverse Reaction and Pathological Observation of Regional Arterial Perfusion Chemotherapy During Radial Resection of Gastric Cancer
- 稿件编号:
- 201001005
- Author(s):
- XIA Shu-sen 1; WANG Chong-shu 1; WEI Shou-jiang 1; ZHNAG Cai-quan 2; DU Jiang 1; WANG Xian-yan 1
- 1.The First Department of General Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;
2.Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- 关键词:
- ; 胃癌; 术中区域动脉灌注化疗; 病理学; 毒副反应
- Keywords:
- ; Gastric cancer; Regional arterial perfusion chemotherapy; Pathology; Toxic and adverse reaction
- 分类号:
- R656.61； R735.2； R730.53
- DOI:
- -
- 文献标识码:
- A
- 摘要:
-
目的 观察胃癌根治术中区域动脉灌注化疗后的药物分布特征、术后组织病理变化及临床毒副反应。
方法 将我科自2007年9月至2008年11月期间符合区域动脉灌注化疗纳入适应证的60例患者随机平均分为治疗组和对照组,治疗组于胃癌根治术中经肿瘤的主要供血动脉灌注含2 ml亚甲蓝、5-FU (1 000 mg/m2)和MMC (10 mg/m2)的灌注液100 ml; 对照组不进行区域动脉灌注化疗。观察术中亚甲蓝的分布特征，术后观察肿瘤组织病理学改变及临床毒副反应。
结果 治疗组肿瘤区域立即显色,此后染色逐渐变淡,但全手术过程中肿瘤区域仍可见染色。术后光镜观察见癌细胞出现轻度细胞核固缩或肿胀,细胞浆凝固,细胞间质轻度水肿,炎性细胞浸润,部分病例可见轻度血管炎表现。透射电镜见癌细胞核固缩或肿胀,核异染色质凝集,核周间隙扩大,胞质线粒体肿胀,内质网扩张,高尔基复合体扩张。治疗组术后第1天AST较术前明显增高(P<0.01),但术后第3天即恢复正常(P>0.05); 2组患者术后肝功能其余指标(ALT、ALP、GGT、LDH)、肾功能指标(尿素和肌酐)、毒副反应(胃肠道反应和骨髓抑制)及床旁心电图差异均无统计学意义(P>0.05); 2组均未出现吻合口漏。
结论 胃癌根治术中区域动脉灌注化疗后使胃癌原发灶在全手术过程暴露于化疗药物中,可降低癌细胞的活性; 临床观察其毒副反应小,可作为外科手术的重要补充手段来预防术中医源性扩散和术后的复发。
- Abstract:
-
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 (P<0.01), and recovered normal on the third day (P>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 (P>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.
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备注/Memo
- 备注/Memo:
- 【通讯作者】王崇树,E-mail: chongswang@163.com
【作者简介】夏术森(1982年-)，男,山东省潍坊人,硕士研究生,医师，主要研究方向为胃肠外科,E-mail: xsx0639@163.com。
2009-09-30收稿, 2009-11-06修回
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