胃肠癌肝转移经肝动脉栓塞及皮下药盒持续灌注化疗的疗效初探

目的本研究观察经肝动脉栓塞化疗和(或)肝动脉插管持续灌注化疗治疗晚期胃肠癌肝转移的临床疗效.方法 22例无外科手术指征的晚期胃肠癌肝转移患者经肝动脉介入治疗共72次,单采取Seldinger法肝动脉内插管皮下埋置药盒持续灌注化疗48次,或先用吡柔比星(THP)60 mg/m2和DDP 50 mg/m2加入超液化碘油10～30 ml进行肝动脉栓塞化疗再联合肝动脉持续灌注化疗共24次.肝动脉插管灌注的方案:CF 200 mg/m2,d1,d14,静脉滴入;顺铂(DDP)50 mg/m2,d1,或用奥沙利铂100～130 mg/m2,d1,从皮下药盒处缓慢推入;5-Fu 2 000～2 500 mg/m2,d1,d14,装入美国百特公司的便携式输液泵持续动脉灌注48 h.结果总有效率(完全缓解 部分缓解)为59.0%.肿瘤负荷＜30%者的有效率为77.8%,明显高于肿瘤负荷＞30%者(46.2%,P＜0.005).本组患者主要不良反应为肝功能损害、发热及胃肠道反应等,经相应对症处理可缓解.结论经肝动脉栓塞及插管持续化疗是治疗胃肠癌肝转移的安全有效方法,值得临床推广.

Preliminary results of chemoembolization and continuous hepatic infusion chemotherapy for treatment of patients with liver metastases from gastrointestinal cancer

Objective To evaluate the efficacy of continuous hepatic artery infusion chemotherapy and chemoembolization in the treatment of liver metastases from gastrointestinal cancer. Methods A total of 22 cancer patients were treated 72 times with continuous hepatic artery infusion chemotherapy and chemoembolization. Infusion chemotherapy alone was performed 48 times, or pirarubicin 60 mg/m2 and cisplatin 50 mg/m2 mixed with lipi-odol ultra-fluid for chemoembolization combined with infusion chemotherapy were performed 24 times. Chemothera-peutic agents for continuous hepatic arterial infusion used were calcium folinate 200 mg/m2 , d1-d2/d14-d15, and fluorouracil 2 000-2 500 mg/m2 d1-d2/d14-d15,cisplatin 50 mg/m2 d1 or oxaliplatin 100-130 mg/m2 d1 .Results An overall response rate (CR PR) of the cases was 59.0% .The response seemed to correlate with the intrahe-patic tumour burden. A 77.8% response rate was observed in intrahepatic tumour burden less than 30% versus 46. 2% response rate in those with tumor burden higher than 30% ( P < 0.005). There was no severe side effect or complications. Conclusion Continuous transcatheter hepatic artery infusion chemotherapy and chemoembolization may be a safe and effective methods for the treatment of the patients with liver metastases from gastrointestinal cancer and worthwhile for further study.