乳腺癌术前经动脉新辅助化学治疗及栓塞的疗效分析

目的探讨乳腺癌患者外科术前经动脉化学治疗药物灌注并栓塞供养血管后,对外科手术方式以及疗效的影响。方法23例女性单侧乳腺癌确诊患者,在外科手术前6～17 d,行锁骨下动脉局部化学治疗药物灌注和栓塞,化学治疗药物采用FAC/FEC方案,栓塞剂为碘化油和明胶海绵。外科手术前1～3 d行钼靶摄片,测量肿块变化,记录手术出血量和手术方式。结果经动脉化疗灌注栓塞无严重并发症;化学治疗灌注栓塞后5～15 d,部分缓解61%(14/23),病变稳定39%(9/23);20例患者行乳腺癌改良根治术,3例患者行保乳手术。手术出血量45～400 mL,平均出血量(141±96)mL,并与同时期同科室52例乳腺癌改良根治手术(术前未化学治疗栓塞)的出血量90～450 mL,平均(209±83)mL进行对比,差异有统计学意义(P<0.05)。结论乳腺癌术前经动脉新辅助化学治疗及栓塞供养动脉,可使肿块缩小,减少术中出血量,利于手术切除,并增加保乳手术的机会。

The analysis of the efficacy of intra-arterial chemotherapy and arterial embolization before breast cancer surgery

Objective To explore the effect of intra-arterial chemotherapy perfusion and embolization of feeding vessels before surgical treatment of breast cancer patients.Methods Twenty-three cases of women patients diagnosed with unilateral breast cancer,before surgery 6 to 17 d,subclavian arterial local chemotherapy drug perfusion and embolization,chemotherapy drugs for FAC/FEC,embolization agent was iodized oil and gelatin sponge.Mammography 1~3 d before surgery,measurement the change of mass.Record the loss of blood and surgery methods.Results No serious complications by intra-arterial chemotherapy infusion embolism;5~15 d after chemotherapy drug perfusion and embolization,partial remission（PR） 61%（14/23）,stable disease（SD） 39%（9/23）;20 cases with modified radical mastectomy,3 cases with breast-conserving surgery.Operative bleeding 45~400 mL（141±96）,and compared with 52 cases modified radical operation of breast cancer which was no chemotherapy and embolization before surgery in general surgery department in the same period,which was bleeding 90~450 mL（209±83）,there was significant difference（P0.05）.Conclusion Before surgery of breast cancer,intra-arterial chemotherapy and embolization main breadwinner of the artery can reduce tumor size and blood loss in surgery,conducive to removal tumor by surgery,and increase the chance of breast-conserving surgery.