术前介入化疗及栓塞对贲门癌的治疗价值

目的 探讨术前经胃左动脉灌注化疗药物及栓塞对贲门癌的治疗价值。方法 将入选病例随机分成两组:①试验组(介入化疗栓塞+手术组)30例;②对照组(单纯手术组)30例。试验组采用Seldinger穿刺插管技术将导管插至胃左动脉,采用FAM或FAD方案进行区域性灌注化疗并以明胶海绵颗粒栓塞,栓塞后7～10d行贲门癌根治术,对手术所见、病理表现及生存状况进行对照研究。结果 试验组手术所见病灶缩小(占83％),肿瘤轻度水肿,缺血,术中出血量少,手术易切除。按病理所见分为4级:0级:无效(0例);Ⅰ级:轻度有效(2例);Ⅱ级:中度有效(25例)Ⅲ级:显效(3例)。两组比较差异有显著性(P<0.01)。生存期试验组术后1、2、3年生存率分别为90.0％、80.0％和60.0％,较对照组1、2、3年生存率76.7％、66.7％和46.7％明显延长(P<0.05)。结论 术前介入化疗及栓塞能使肿瘤缩小,肿瘤显著坏死,可减少术后复发及转移,提高生存期。

Clinical evaluation of the preoperative interventional chemotherapy and embolization for esophageal cardiac carcinoma

Objective To study the clinical value of preoperative infusion chemotherapy and em-bolization through gastrica sinistra artery for esophageal cardiac carcinoma. Methods 60 cases were divided into two groups: experimental group(interventional chemotherapy embolization and operation group)30 cases and comparison group(simple operation group)30 cases. In the first group, transfemoral artery Seldinger's catheterization was undertaken by introducing the catheters into the gastrica sinistra arteries with infusion of arterial chemotherapeutics under the project FAM or FAD together with embolization of gelfoam granules. Radical resection of cardiac carcinoma was performed 7 to 10 days after the procedure. The course of the operation, pathological results and survival condition were studied comparatively between the two groups. Results In experimental group, tumor size was reduced (83% ) with mild edema and ischemia, outcoming with less bleeding during operation and easier to be removed. There were 4 grades in pathological results: 0:no effective (0 case) i :mild effective(2 cases) 2 :moderate effective(25 cases), 3 very effective (3 cases). There were significant differences between the two groups (P < 0. 01). 1,2,3 year survival rates were 90.0% , 80.0% and 60.0% for patients in the experimental group, and 76.7% ,66.7% and 46.7% for those in the comparison group, respectively(P< 0. 05). The survival rates for experimental group were significantly higher than the comparison group. Conclusion Preoperative interventional chemotherapy and embolization can reduce the tumor size, causing the tumor necrosis significantly and reducing the recurrence and metastatic rates; and thus increase the survival rate.