用户名: 密码: 验证码:
应用羟基喜树碱介入治疗中晚期贲门癌的临床研究
详细信息    本馆镜像全文|  推荐本文 |  |   获取CNKI官网全文
摘要
目的:评估羟基喜树碱(hydroxycamptothecin,HCPT)介入治疗贲门癌(cardiac carcinoma)的临床价值,为临床应用羟基喜树碱提供可靠的依据。方法:69例贲门癌患者随机分成两组,实验组:33例,羟基喜树碱、超液态碘化油(又称乙碘油)混合液栓塞肿瘤供血动脉;对照组:36例,阿霉素(Doxorubicin,ADM)、乙碘油混合液栓塞肿瘤供血动脉。所有患者均在DSA下行胃左动脉灌注栓塞化疗术。观察两组术后肿瘤缩小率、近期疗效、毒副反应和生存状况(术后6、12、24个月生存率)。结果:实验组栓塞治疗后,有效率为87.9%,对照组有效率为80.6%,无显著性差异;实验组术后6、12、24个月生存率分别为90.9%、63.6%、42.3%,平均生存期为20.5±4.1月;对照组患者术后6、12、24个月生存率分别为86.1%、44.4%、16.7%,平均生存期为15.0±5.3月,两组比较(P值<0.05)有显著差异;伴有转移者生存期明显短于无转移者(P值<0.05);术后实验组症状改善及Kamofasky评分升高都较对照组明显(P值<0.05);两组毒副反应有显著差异(P值<0.05)。结论:羟基喜树碱灌注栓塞治疗中晚期贲门癌,介入治疗栓塞后肿瘤转移复发率低,毒副反应发生率低,可明显提高介入治疗的疗效和患者的远期生存率,并改善患者生存质量。
Objective: To observe the clinical effects of hydroxycamptothecin on the embolization of cardiac carcinoma. Method: 69 cases with cardiac carcinoma were randomly divided into two groups: Test group and control group. Test group included 33 cases treated with mixture of hydroxycamptothecin and iodine oil, control group included 36 cases with ADM and iodine oil. All the patients were operated with chemotherapy and embolization traps left gastric artery under DSA. To observe recent effects, toxication and side effects and survival condition (postoperative survival rate in 6, 12 and 24month, respectively) . Results: recent effects in test group were 87.9%, were no difference from that of control group(80.6%). Postoperative survival rate of test group were 90.9%、63.6%、and 42.3% in 6, 12, and 24 month respectively, the average survival time was 20.5±4.1 months. And Postoperative survival rate of control group were 86.1%、44.4%、and 16.7%, the average survival time was 15.0±5.3 months. There were remarkably different between the two groups (P<0.05). The postoperative survival time of the patients without metastasis were remarkably different from those with metastasis (P<0.05). The side effects and toxications of two groups were remarkably different (P<0.05). Conclusion: hydroxycamptothecin used in cardiac carcinoma with interventional therapy could reduced the reccurence and transfusion of tumor, remarkably increase the survival rate.
引文
[1] 周琦,王立东.贲门癌的生物学特征.华人消化杂志,1998,6:636-637.
    [2] KabatGC, Stephen KCNg, Wynder EL. Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric carnoma. Cancer Causes and Control, 1993; 4(2):123-132.
    [3] Fuchs CS, Mayer RJ. Gastric carcinoma(medical progress). The New England J. of Medicine, 1995; 6(3):314.
    [4] Moller H. Incidence of cancer of esophagus, cardia and stomach in Denmark. European J. of Cancer Prevention, 1992; 1 (2):159-164.
    [5] Tong ZZ, Mayne ST, Holford TR, Boyle P, Liu WL, Chert Y, Mador M, Flannery J. The time Trend and Age-Period-Cohort Elects on Incidence of Adenocarcinoma of the Stomach in Connecticut from 1955-1989. Cancer; 1993, 72(2): 330-340.
    [6] 常秋玲,陈维汉,杨文献.河南省恶性肿瘤死亡流行趋势分析.中国肿瘤,1993, 11(1):12-13.
    [7] 丘世勋,王英.对683例老年上消化道癌肿高发人群抽样调查分析.内镜,1994,11:37-38.
    [8] Hansson LE, Ekstrom AM, BergstromD Sc R, et al. Carcinoma of the gastric cardia: surgical practices and short-term operative results in a defined Swedish population. World-J-Surg, 2000; 24(4): 473-8.
    [9] 徐乐天,李留琛,朱忠信,等.经胸全胃切除术治疗贲门胃底癌(附90例报告).中华外科杂志,1992,30(1):44-45.
    [10] 王德元,张熙曾,吴德泰.等.胃贲门癌两种根治术的疗效比较.中国肿瘤临床,1987,14(3):140-113.
    [11] 务森,张熙曾.贲门癌预后多因素分析和术式对比研究.中华肿瘤杂志,1997,19(5):395-397.
    [12] 陈少湖,安圭山.现代食管癌贲门癌诊疗学.科学出版社,2002,第一版,2.
    [13] 张新华,周晓军,李德本.胃肿瘤WHO分类之2002年版新特点.中华消化内 镜杂志,2004,1:64-66.
    [14] 詹晓星.介入放射学中药代动力学研究.国外医学.临床放射学分册,1989,6(6):327.
    [15] Maurer CA, Borner M, Buchler MW, etal. Regionalchemotherapy of gastrointestinal cancer. Dig Surg, 1997, 14(1): 9.
    [16] 中华人民共和国卫生部医政司.中国常见恶性肿瘤诊治规范.1991,第一分册:10.
    [17] 中华人民共和国卫生部医政司.中国常见恶性肿瘤诊治规范.1991,第一分册:5.
    [18] 中华人民共和国卫生部医政司.中国常见恶性肿瘤诊治规范.199l,第一分册:25.
    [19] 王建华,王小林,颜志平.腹部介入放射学,上海:上海医科大学出版社,119~123.
    [20] Hsiang YH et al. Identification of manmalian DNA topoisomerase 1 as an intracelelular target of the anticancer drug camptothecin. Cancer Res. 1988; 48: 1722.
    [21] Rowe PM. Camptothecin: new enthusiasm for and old drug. Lancet, 1995; 347: 892.
    [22] Meikle I, in human Cummings J, Macpherson JS, etal. Induction of apoptosis cancer cell lines by the novel anthracenyl amino acid topoisomerase inhibitor NU/ICRF505. Br J Cancer, 1996 74:374-379.
    [23] 胥彬,刘建,张振德.羟基喜树碱的药理研究与临床应用.中国肿瘤临床,2000增刊:3-14.
    [24] 吕星.作用于DNA拓扑异构酶的抗癌药研究.中国肿瘤临床,2000,27(增刊):18
    [25] 李振.恶性肿瘤的化学治疗与免疫治疗.北京:人民卫生出版社,1990,第一版:21.
    [26] 涂水平,吴裕忻.细胞凋亡与消化道肿瘤.内镜,1997,3:60-65.
    [27] 刘健.羟基喜树碱类药物作用机制及在合并治疗中机理的研究.中国肿瘤临床,1998,25(5):389.
    [28] 周军,樊亦军,陈宝南,等.喜树碱(CPT)与10羟基喜树碱(HCPT)的抗肿瘤活性与毒性比较.癌症,2000,10:198.
    [29] Zhou YH, Xu B. Antitumor effect of oral administration of 10-hydroxycamptothecin. Acta pharmacologica sinica. 1999;20(1):93.
    [30] 刘健,胥彬.喜树碱类药物抗癌制剂合并治疗机制的研究.中国肿瘤临床,1998,25:389.
    [1] 周琦,王立东.贲门癌的生物学特征.华人消化杂志,1998,6:636-637.
    [2] Kabat GC, Stephen KCNg, Wynder EL. Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric carnoma. Cancer Causes and Control, 1993; 4(2):123-132.
    [3] Fuchs CS, Mayer RJ. Gastric carcinoma(medical progress). The New England J. of Medicine, 1995; 6(3):314.
    [4] Moller H. Incidence of cancer of esophagus, cardia and stomach in Denmark. European J. of Cancer Prevention, 1992; 1(2):159-164.
    [5] Tong ZZ, Mayne ST, Holford TR, Boyle P, Liu WL, Chen Y, Mador M, Flannery J. The time Trend and Age-Period-Cohort Elects on Incidence of Adenocarcinoma of the Stomach in Connecticut from 1955-1989. Cancer; 1993, 72(2):330-340.
    [6] 常秋玲,陈维汉,杨文献.河南省恶性肿瘤死亡流行趋势分析.中国肿瘤,1993,11(1):12-13.
    [7] 丘世勋,王英.对683例老年上消化道癌肿高发人群抽样调查分析.内镜,1994,11:37-38.
    [8] Hansson LE, EkstromA M, BergstromD Sc R, et al. Carcinoma of the gastric cardia: surgical practices and short-term operative results in a defined Swedish population, World-J-Surg, 2000; 24(4): 473-8.
    [9] 徐乐天,李留琛,朱忠信,等.经胸全胃切除术治疗贲门胃底癌(附90例报告).中华外科杂志,1992,30(1):44-45.
    [10] 王德元,张熙曾,吴德泰,等.胃贲门癌两种根治术的疗效比较.中国肿瘤临床,1987,14(3):140-143.
    [11] 务森,张熙曾.贲门癌预后多因素分析和术式对比研究.中华肿瘤杂志,1997,19(5):395-397.
    [12] 孙荣跃,陈君坤.贲门癌的数字减影血管造影.医学影像杂志,1998,5:63.
    [13] 苏明涛,陈裕明.胃左动脉内化疗灌注与合用栓塞治疗晚期贲门癌.中华医学杂志,1997,77:797.
    [14] 金雪熙,杨大明,徐幼龙,等.胃癌术前选择性动脉灌注化疗.介入放射学杂志,2001,10(6):344.
    [15] 谢印法,薛德文,于竹成,等.胃左动脉灌注栓塞结合放射治疗晚期贲门癌.中国肿瘤临床与康复,2001,8(1):94.
    [16] 李麟荪.临床介入治疗学,南京:江苏科技出版社,1994.11.
    [17] Lentz BMT, Regional distribution of cardiac output: normal values on man determind by video diluton techigut. AJR, 1981; 137:903.
    [18] 谢其康,李焕祥,张茜,等.进展期胃癌的血管造影表现和动脉灌注化疗.实用放射学杂志,1993,9:599.
    [19] 李茂全.不能手术的胃癌介入放射学治疗进展(综述).国外医学·临床放射学分册,1993,16(1):1.
    [20] 李荗全,林炎,胡锡琪,等.胃动脉内化疗灌注与合用栓塞的对照研究.中华放射学杂志,1994,28:153.
    [21] 高中度,茅爱武,邵维城,等.动脉灌注化疗药物及LAK/11.22治疗晚期贲门癌.齐鲁肿瘤杂志,1998,5(4):275.
    [22] 王舒宝,,叶胜龙,崔正言,等.重组白介素22治疗恶性肿瘤的一期临床试验报告,实用肿瘤学杂志,1995,g(3):22.
    [23] Lissonip, Lopegm, Mass RA, etal. Second Line the rapyw with Lowdose Subcutaneous inter leukin-2 alone in advancedvenal cancer patientws resistant to interferoua. Eur J cancer, 1992; 28: 92.
    [24] 刘汉举,严晓红,邓鸿鹏.中药加介入治疗中晚期贲门癌60例临床观察.浙江中西医结合杂志.2003,13(1):34.
    [25] 张士舜.胃癌中医研治集成.北京:中国科学技术出版社,2001,244-398.
    [26] 苑静波,苏春芝,刘兆勋,等.中药扶正消瘤汤配合介入疗法治疗贲门癌疗效观察.四川中医,2005,23(7):34.
    [27] 李忠.临床中医肿瘤学[M].沈阳:辽宁科学技术出版社,2002:59-62,334-336.
    [28] 张长斌.扶正抗癌方治疗晚期胃癌62例临床观察.现代康复,1999,2(1):484-485.
    [29] 杨继泉,张斌斌.中医药治疗中晚期胃癌102例临床疗效分析.中医杂志,2000,41(8):483-484.
    [30] 苗文红.补肾健脾法治疗肿瘤放化疗所致骨髓抑制98例.陕西中医,2000,21(7):289-290.
    [31] 朱兴来.中西医结合治疗胃癌体会.安徽中医学院学报,2000,19(6):43-44
    [32] 刘永华,韩铭钧,柳学国,等.进展期贲门癌术前胃左动脉化疗栓塞的临床应用.中国肿瘤临床与康复,2004,11(3):231.
    [33] 崔惠英,齐广珍.贲门癌术前介入化疗的临床应用.山西医科大学学报,2002,33(4):353.
    [34] 郭玉林,马菁,王小东,等.贲门癌术前胃左动脉药物灌注化疗.实用放射学杂志,2002,18(1):48.
    [35] 王立富,庞煜.贲门癌术前胃左动脉灌注疗效分析.镇江医学院学报,2001,11(1):77.
    [36] Frimberger E. Expanding spiral: a new type of prosthesis for the palliative treatment of malignant esophageal stenoses. Endoscopy, 1983; 15(2): 213-214.
    [37] Siersema PD, Schrauwen SL, Blankenstein M, et al. Self-expanding metal stens for complicated and recurrent esophagogastric cancer. (iastrointest Endosc, 2001; 54(5):579-586.
    [38] 霍裕民,陈丽颖,许孝新,等.微波凝固并放置支架治疗全梗阻性食管癌26例.中华理疗杂志,2001,24(6):365-366.
    [39] Acunas B, Rozanes I, Akpinar S, et al. Palliation of malignant esophageal strictures with self-expanding nitinol stens: drawbacks and complications. Radiology,1996;199(3): 648-652.
    [40] 张士义,林松森,段林生,等.瘤体内局部注射免疫化学药物配合外照射治疗晚期食管癌的临床观察.中国肿瘤临床,2001,28(10):786-787.
    [41] Micheau O, Solary E, Hammann A, et al. Sensieization of cancer cells with cytotxic drugs to fas-mediated cytoxiciey. J Natl Cancer Inst, 1997; 89(11): 783-789.
    [42] 辛育龄,徐邦宁主编.癌症的电化学治疗.北京:人民卫生出版社,1995:52-65
    [43] 李麟荪.介入放射学.第1版.北京:中国科学技术出版社,1999:73-138
    [44] 高中度,许锡元,茅爱武,等.放疗联合介入治疗晚期贲门癌.肿瘤研究与临床,1999,11(2):99.
    [45] 谢印法,于竹成,李玲,等.胃左动脉灌注栓塞结合放射治疗晚期贲门癌.中国肿瘤临床与康复,2001,8(1):94.
    [46] 付维利,王利.消化系统恶性肿瘤的介入放射治疗学[M].辽宁科技出版社,第1版,1997:111-125.
    [47] 苗进义.晚期贲门癌单纯放射治疗观察.山西医药杂志,1993,22(5):314.
    [48] 秦庆亮.局部化疗加放疗治疗进展期食管癌.中华肿瘤杂志,1998,6:430
    [49] 谢大业,包桂霞,林俊生,等.现代临床医学生物工程学杂志.2002,8(5):225-336
    [50] SongllY, Choi KC, Cho BIt, et al. Esophagogastric neoplasma: Palliation with a modified gianttJrco stent. Radiology,1991; 180:349.
    [51] Cantero-R. Palliative treatment of esophageal cancer: Self-expanding metal stents versus post leth wait technique. Hepatogas Troenterology, 1999, 46(26):971-976.
    [52] Bartelsman. Palliation of patients with esophagogastric neoplasms by insertion of a covered expandable modified Cianturco z endoprostnesis. GrastroinEndose, 2000; 51(2):134-138.
    [53] Zaragozano-Guillen-R. Our experience with Wallstent self-expanding metal prostneses in 65 patients with malignant dysphagia. Rev Esp Enferm Dig, 1999; 91(11):700-747.
    [54] 杨仁杰,张宏志,黄俊,等.被覆支架成型术在食管癌姑息治疗中的应用.中华放射学杂,1995,29(7):461-464.
    [55] 翟仁友,戴可定.食管支架治疗食管良恶性狭窄(附23例分析).中华放射学杂志,1995,29(7):465-468.
    [56] 马贵,王志存,张德昌,等.食管癌术后吻合口狭窄的介入治疗.中国临床医学影像杂志,1999,10(1):58-59.

© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号

地址:北京市海淀区学院路29号 邮编:100083

电话:办公室:(+86 10)66554848;文献借阅、咨询服务、科技查新:66554700