经皮左锁骨下动脉化疗药盒植入治疗胰腺癌的临床研究

目的探讨左锁骨下动脉植入化疗药盒对不能手术切除胰腺癌的治疗价值,方法不能手术切除的胰腺癌患者145例,随机分为2组。介入化疗组:73例,经皮左锁骨下动脉植入化疗药盒,将导管前端置于肝总动脉,经药盒介入化疗。全身化疗组:72例,静脉给药全身化疗。采用FAM方案,7d为一疗程,间隔1～2个月重复下一疗程。结果介入化疗组行2～10次化疗,平均7.6次。完全缓解(CR)4例,部分缓解(PR)49例,有效率(CR+PR)为60.2%;生存期3～34个月,中位生存时间13.5个月。全身化疗组行1～7次化疗,平均3.8次。无CR病例,PR25例,有效率为34.7%;生存期1～13个月,中位生存期6.2个月,2组有效率和生存期比较差异均有统计学意义(P<0.05)。在临床症状方面,介入化疗组中56例患者有顽固性疼痛,化疗2～3周后27例疼痛完全消失,22例不同程度缓解,占87.5%。全身化疗组有疼痛54例,化疗后疼痛完全消失11例,缓解14例,占46.3%。介入化疗组治疗过程中无严重的肝、肾、心脏和骨髓损害,25例出现轻微的胃肠道反应和白细胞降低,占34.3%,均不影响继续化疗。全身化疗组3例出现严重骨髓抑制,1例死亡,肝、肾功能也有不同程度损害,发生胃肠道反应和白细胞降低67例,占90.3%,2组不良反应无论在发生率和严重程度上比较,差异均有统计学意义(P<0.01)。结论经化疗药盒行局部规律性介入化疗治疗胰腺癌可明显改善患者生存质量,提高生存率,是值得选择的较好疗法

Regional chemotherapy with percutaneous left subclavain artery implantation of port-catheter drug delivery system for inoperable pancreatic carcinoma

Objective To evaluate the therapeutic effect of implanted drug delivery system (DDS) in patients with inoperable pancreatic carcinoma.Methods During 1998 to 2004,145 patients with no indication for operation were randomly divided into two groups.In 73 patients with regional interventional chemotherapy group (group A),percutaneous left subclavain artery port-catheter DDS implantation with the tip in common hepatic artery was performed, and regional chemotherapy infusion were done in every 1 to 2 month. In 72 patients with systemic chemotherapy group (group B), the chemotherapy were given via peripheral vein in every 1 to 2 month. The FAM(adriamycin 40 mg/m2+mitomycin 6 mg/m2+fluorouracil 375 mg/m2) were selected in two groups. Results In group A, after 2-10 (average 7.6) cycles of chemotherapy, 4 patients reached complete release (CR) and 49 patients reached partial release (PR). In group B, after 1-7 (average 3.8) cycles of chemotherapy, no patient reached CR and 25 patients reached PR. The effective ratio was 60.2% and 34.7% in group A and B, respectively. The survival time ranged from 3 to 34 months (median 13.5 months) in group A and 1 to 13 months (median 6.2 months) in group B. Among the 56 patients with obstinate pain in group A, 27 patients were free of pain and 22 patients got partially alleviation 2-3 weeks after chemotherapy. Among the 54 patients with obstinate pain in group B, 11 patients were free of pain and 14 patients got partially alleviation 2-3 weeks after chemotherapy. The pain-releasing ratio in group A and group B was 87.5% and 46.3%. There were no severe damage of liver, kidney, heart and bone marrow in group A. Twenty five patients in group A experienced mild digestive side-effect and decrease of white blood cells, all of them completed the chemotherapy. In group B, 3 patients experienced bone marrow arrest, one died of severe damage of liver and kidney, and 67 patients displayed digestive side-effect and decrease of white blood cells. The ratio of side-effect in group B was 90.3%. The differences of effective ratio, survival time and side-effect ratio between group A and B were statistically significant (P<0.05 or P<0.01). Conclusions Interventional arterial infusion chemotherapy with DDS significantly improves quality of life and prolongs survival time for the patients with advanced pancreatic carcinoma.