32P-磷酸铬组织间照射在食管、贲门癌手术中的应用评价

目的　研究32 P 磷酸铬 (32 P 胶体 )术中间质给药行组织间照射在食管、贲门癌治疗中的作用。方法　对 91例食管、贲门癌临床确诊病例 ,在剖胸手术中切除病变食管及胃体后 ,于病灶相应部位及其淋巴引流区域间质组织内多点浸润注射 ,未能切除病灶者注射于瘤体组织及其淋巴引流区域内 ,32 P胶体剂量为 2 96～ 370MBq 10ml。对照组 99例为同期同病种单纯手术病例。观察两组围术期并发症发生情况、淋巴结转移时间、淋巴结转移率及术后 1、3和 5年生存率。结果　手术 32 P胶体组及单纯手术组均无手术死亡 ,围术期并发症发生率两组差异无显著性 (P >0 0 5 )。两组术后淋巴结转移时间、纵隔淋巴转移率、锁骨上淋巴结转移率和腹腔淋巴结转移率差异有显著性(P <0 0 5 )。术中切除肿瘤的手术 32 P胶体组术后 1、3和 5年生存率分别为 72 5 %、5 6 4 %、4 2 6 % ,单纯手术组分别为 6 7 7%、38 1%、2 5 0 %。术后 1年生存率两组差异无显著性 (P >0 0 5 ) ,术后 3及 5年生存率两组差异有显著性或非常显著性 (P <0 0 5 ,P <0 0 1)。结论　32 P胶体间质给药应用于食管、贲门癌手术中 ,方法简单 ,使用安全 ,在控制术后淋巴结转移及提高中远期生存率方面具有良好的临床疗效

Interstitial irradiation using 32P-chromic phosphate during resection of cardio-esophageal carcinoma

Objective\ To explore the effectiveness of ()~(32)P-chromic phosphate (()~(32)P-colloid) by stromal injection during cardio-esophageal carcinoma resection. Methods\ To 91 patients with clinically diagnosed cardio-esophageal carcinoma,infiltrative injection of ()~(32)P-colloid (296-370 MBq/10 ml) was administer either into the interstitial tissues neighboring to the site of lesion and the region of lymphatic drainage after resection of the tumor or,for those patients whose tumor could not be removed,()~(32)P-colloid was injected into the tumor proper and the lymphatic drainage region.The control group included 99 patients with the same diagnosis,who were operated in the same period of time but not injected with ()~(32)P-colloid.The peri-operative complication,time and rate of lymphatic metastasis,and the post-operative survival rates at 1-,3-,and 5-year were followed. Results\ No operative death occurred in both groups.The incidences of peri-operative complication were not different statistically between these two group (P>0.05).The time of lymph node metastasis and the incidences of mediastinal,supraclavicular,and abdominal lymph node metastasis were all statistically different between these two groups (P<0.05).The 1-,3-,and 5-year survival rates were 72.5%,56.4%,and 42.6%,respectively,in the injection group,and were 67.7%,38.1%,and 25.0% in the control group.The 1-year survival rates were not different statistically (P>0.05) between these two groups,while the 3- and 5-year rates were significantly diffeent (P<0.05,P<0.01). Conclusion\ Stromal medication of ()~(32)P-colloid during cardio-esophageal carcinoma resection is a simple and safe procedure in controlling the post-operative lymphatic metastasis and has very fair clinical effectiveness in improving intermediate and late survival rates.