动脉化疗治疗头颈部恶性肿瘤的临床研究

目的研究超选择性动脉介入灌注化疗和栓塞治疗头颈部恶性肿瘤的价值。方法31例头颈部恶性肿瘤患者根据肿瘤部位分别行超选择性舌动脉、颌内动脉、面动脉介入灌注化疗,其中明胶海绵颗粒栓塞11例。化疗药物采用顺铂(CDDP)、5-FU、甲氨碟呤(MTX)、表阿霉素(EPI)等2～3种联合应用。结果31例头颈部恶性肿瘤选择性动脉插管化疗和栓塞,半月后肿瘤体积缩小21例(占67.8%);肿瘤溃疡面缩小8例(占25.8%);未见明显变化2例。组织学疗效:19例介入治疗后接受手术,10例栓塞后的手术标本均为显效,栓塞标本近栓塞的血管处坏死程度重;9例未栓塞标本为有效。19例手术标本病理观察有效率94%。术中见肿瘤缩小,边界清楚,出血减少。19例术后目前仍生存15例(占78.9%),存活时间1～7.5年。结论术前超选择性动脉插管化疗栓塞对头颈部恶性肿瘤有较好的临床应用价值。

Clinical study on arterial infusion chemotherapy for the head and neck malignant tumors

Objective To investigate the value of superselective arterial infusion chemotherapy/embolization in treating head and neck malignant tumors. Methods 31 patients with head and neck carcinomas were individually completed the interventional infusion chemotherapy through superselective lingual artery, maxillary artery and facial artery according to tumor location; among them, 11 cases received gelatin sponge particles embolization. The chemotherapeutic drugs of CDDP, 5-FU, MTX, EPI were used but we often chose two to three drugs in combination for practical application. Results The gross tumor volumes of 21 cases decreased in 15 days after the procedure(67.8%). Tumor ulcers of 8 cases reduced in size(25.8%),2 cases showed no obvious change. The histological therapeutic effect: 19 cases adopted operation after arterial infusion, 10 operative samples after embolization revealed slight improvement and extensive necrosis occurred in the region nearby the embolization vessels. Slight effect was demonstrated on 9 specimens without embolization. The response rate was 94% in pathological observation of 19 cases. Operation revealed that tumors were deflated, with clear boundary and less hemorrhage 15 patients still survived in 19 cases(78.9%)with the survival time of 1 -7.5 years. Conclusion Clinical application of preoperative superelective arterial chemoembolization in head and neck malignant tumors would provide better clinical prognosis.