口腔癌动脉插管栓塞化疗术

目的观察晚期口腔癌介入栓塞化疗后的病理学改变及效果。方法20例患者(舌癌16例,牙龈癌2例,口底癌2例)在DSA监测下,采用Seldinger's 技术,由股动脉插管进入同侧颈外动脉并确定相应的供血血管,注入阿霉素、顺铂及丝裂霉素C,同时用明胶海绵栓塞。结果栓塞后1~2周手术,其中1例术后4周手术,组织学光镜及电镜观察发现肿瘤组织发生了明显改变,如细胞数量减少,核固缩、孔泡变性以及局部凝固性坏死,坏死裂解的癌巢由增生的纤维结缔组织包裹机化,同时较多的炎性细胞浸润。结论对晚期口腔癌患者给予动脉插管介入栓塞化疗术可导致肿瘤组织的变性坏死;肿瘤与周围组织界限清楚,有利于术中区别组织界限,提高手术成功率;对于无法手术的患者,该方法可抑制肿瘤的生长,延缓生命。

Transcatheter arterial chemoembolization of oral squamous-cell carcinoma:a clinicopathological observation

Objective To evaluate the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) for advanced oral carcinoma by observing the pathological changes of the carcinoma tissues after the interventional therapy. Methods Twenty cases of advanced oral carcinoma involving the tongue (16 cases), gingiva (2 cases) and the floor of the mouth (2 cases) were enrolled in this study. Intubation with Seldinger's technique from the femoral artery to the external carotid artery was performed in all the cases. With the assistance of digital subtracting angiography (DSA), cisplatin, adriacin and mitomycin C were injected through the branches of the external carotid artery into the involved tissues with embolization using gelatin sponge. Surgical resection of the tumor was performed 1 to 4 weeks after TACE, and the specimens were observed under light microscope and transmission electron microscope. Results Significant changes occurred in the carcinoma tissues, manifested by reduced carcinoma cells, karyopyknosis, vacuolar degeneration and focal coagulation necrosis. The disintegrated carcinoma nests were encapsulated and underwent organization by hyperplastic fibrous connective tissues with inflammatory cell infiltration. The connective structures between the carcinoma cells disappeared and resulted in broadened intercellular space. Conclusion Preoperative administration of arterial chemoembolization may cause degeneration and necrosis of oral carcinoma, which can be helpful to distinguish intraoperatively the carcinoma from normal tissues; as for the inoperable cases, TACE may inhibit the tumor growth and prolong the survival of the patients.