直肠癌周粘膜下注射抗癌药物对癌组织病理学形态及增殖核抗原表达影响的研究

目的探索、评价直肠癌术前辅助性治疗的新方法。方法直肠癌周粘膜多点连续封闭式注射抗癌药物５氟脲嘧啶（５ＦＵ），丝裂霉素Ｃ（ＭＭＣ）和卡铂（ＣＢＰ），次日手术。光学显微镜下观察原发灶和转移淋巴结内癌细胞变性、坏死程度，免疫组织化学染色检测肿瘤细胞增殖核抗原（ＰＣＮＡ）表达，并作为评判疗效的标准。结果直肠癌原发灶癌细胞变性５１例、坏死率８０％（４１／５１）；淋巴结转移灶变性坏死率为８２６％（１７１／２０７）；原发灶ＰＣＮＡ表达，治疗组阳性率７２％（３７／５１），对照组阳性率１００％（３０／３０），二者差异有显著意义（ｕ＝３１６，Ｐ＜００１）。平均ＰＣＮＡ指数（ＰＣＮＡＬＩ）分别为（４７±１９）％和（３８±１６）％，两者差异有显著意义（ｕ＝５４１，Ｐ＜００５）。淋巴结内癌细胞ＰＣＮＡ表达，治疗组阳性率７７３％，平均ＰＣＮＡＬＩ（４０±１３）％，对照组阳性率９１３％（１２６／１３８），平均指数为（５０±１９）％，两组差异有显著意义（Ｐ＜００５）。结论术前癌周粘膜下注射抗癌药物对原发灶和淋巴结内转移癌有杀伤作用并降低其增殖活性。重复给药可加强疗效，是一种安全有效的直肠癌辅助治疗方法。

Effects of preoperative submucosa chemotherapy on the pathology andexpression of PCNA of rectal carcinoma in 36 cases

Objective To evaluate the effect of a new adjuvant preoperative chemotherapy on patients with rectal cancer. HZMethods Under endoscope submucosal multiple injection of 5FU, MMC and CBP around the tumor foci was given to patients with rectal cancer before radical resection.The effect of this treatment was judged by degeneration and necrosis degree and proliferating cell nuclei antigen expression both in primary lesion and lymphaden with microscopic examination. 5HZResults Degeneration and necrosis were found in 41 out of 51 (80%) primary lesions and 171 out of 207 (826%) cancer involved lymphaden. Positive rate of PCNA expres sion in primary tumor was 72% (37/51) in contrast with 100% in 30 controls (P<001), while the mean PCNALI was (4719)% v.s. (3816)% (P<005).The expression of PCNA in the cancer involved lymphaden was 773% (160/207) in all 51 cases v.s. 913% in 30 controls (P<005) and the PCNALI was (4013)% v.s. (5019)% (P<005). Conclusion Submucosal antineoplasm drugs injection around rectal cancer given preoperatively suppress the malignant biological behavior of tumor cells. Repeat treatment may enhance the effects. It is therefore an effective modality which could be used as a adjuvant measure for the treatment of rectal cancer.