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目的　探讨术前区域性动脉灌注介入化疗在局部进展期胰腺癌治疗中的作用。方法　 1999～ 2 0 0 2年 ,94例局部进展期胰腺癌病人随机分为术前介入化疗组 (6 4例 )和未介入化疗组 (30例 ) ,比较两组病人手术切除率的差异 ,观察介入化疗前后肿瘤大小的改变、疼痛缓解率、血清肿瘤标志物的变化和不良反应程度 ,并通过免疫组化和基因芯片技术分析术前介入化疗对胰腺癌肿瘤相关基因表达的影响。结果　术前介入化疗组和未介入化疗组的手术切除率分别为 4 6 8%和 2 3 3% (P <0 0 5 ) ;术前介入化疗组部分甲基化相关基因 (MBD1、E2F5和Rb)的表达明显被抑制 ,细胞凋亡比值 (bax/bcl 2 )明显增加 ,血清肿瘤标志物水平显著降低 ,病人疼痛明显缓解 (P<0 0 5 )。结论　术前介入化疗能明显抑制胰腺癌肿瘤细胞生长和促进肿瘤细胞凋亡 ,有助于提高手术切除率和改善病人疾病相关症状 ,是胰腺癌综合治疗的有效措施之一。

Effect of preoperative intra-arterial infusion chemotherapy on patients with pancreatic cancer

Objective To discuss the effect of preoperative intra-arterial infusion chemotherapy(IAC)on patients with locally advanced pancreatic cancer. Methods From 1999 to 2002,94 patients with locally advanced pancreatic cancer were divided into group with IAC(n64) preoperatively and control group(n30) without IAC preoperatively in the same period. Change of tumor size, rate of tumor resection, level of serum tumor markers and disease-related symptoms were observed. Expression of tumor related-genes was studied by immunohistochemical method and cDNA microarray in resected samples. Results IAC could reduce the tumor size with the result of much higher resection rate in group with IAC than in control group(46.8% vs 23.3%); in comparison with control group, the ratio of bax/bcl-2 increased significantly,while the expression of nm23-h1, MBD1 and E2F5, Rb decreased remarkably in group with IAC (P<0.05). Disease-related symptoms were improved obviously in group with IAC. There was also significant change in levels of serum tumor markers after IAC. Conclusion Preoperative ICA can improve the disease-related symptoms and increase the surgical resection rate of locally advanced pancreatic cancer by enhancement of tumor cell apoptosis and inhibition of tumor growth.