CAJ | 학술논문

目的探讨动脉内灌注化疗术加栓塞微球栓塞术治疗贲门癌的近期临床疗效.方法前瞻性将39例经病理证实为中晚期贲门癌患者随机分为A、B2组,A组为灌注+栓塞组,共19例,对贲门肿瘤采用介入术中动脉灌注化疗加栓塞微球栓塞的治疗方法;B组为单纯灌注组,共20例,单纯对贲门肿瘤行动脉灌注化疗术.所用化疗方案均为奥沙利铂+脱氧氟尿苷.对2组中伴有肝转移的患者同时行肝转移癌动脉化疗栓塞.对所有患者进行随访,主要随访指标为患者上腹部CT检查结果、消化道造影、血常规、肝肾功能、电解质及大便潜血.计数资料采用x2检验,P＜0.05为差异有统计学意义.采用Kaplan-Meier法计算生存时间,Log-rank检验(Wilcoxon-Breslow)比较2组患者的生存曲线.结果患者随访时间为3～27个月,A组患者中位生存期为17.5个月,6、12和18个月生存率分别为89.5％ (17/19)、84.2％(16/19)和26.3％ (5/19);B组患者中位生存期为12.5个月,6、12和18个月生存率分别为65.0％(13/20)、30.0％(6/20)和0(0/20).2组间生存期的差异有统计学意义(Log-rank检验x2=26.755,P ＜0.01).治疗后2组吞咽困难程度的改善差异有统计学意义(t=2.885,P＜0.01).结论动脉灌注化疗加栓塞微球栓塞术治疗贲门癌可较单纯灌注化疗术更快地缩小肿瘤、快速缓解吞咽困难等症状,提高患者近期生存率,改善生活质量,是一种有效的治疗方法.
목적 탐토동맥내관주화료술가전새미구전새술치료분문암적근기림상료효.방법 전첨성장39례경병리증실위중만기분문암환자수궤분위A、B2조,A조위관주+전새조,공19례,대분문종류채용개입술중동맥관주화료가전새미구전새적치료방법;B조위단순관주조,공20례,단순대분문종류행동맥관주화료술.소용화료방안균위오사리박+탈양불뇨감.대2조중반유간전이적환자동시행간전이암동맥화료전새.대소유환자진행수방,주요수방지표위환자상복부CT검사결과、소화도조영、혈상규、간신공능、전해질급대편잠혈.계수자료채용x2검험,P＜0.05위차이유통계학의의.채용Kaplan-Meier법계산생존시간,Log-rank검험(Wilcoxon-Breslow)비교2조환자적생존곡선.결과 환자수방시간위3～27개월,A조환자중위생존기위17.5개월,6、12화18개월생존솔분별위89.5％ (17/19)、84.2％(16/19)화26.3％ (5/19);B조환자중위생존기위12.5개월,6、12화18개월생존솔분별위65.0％(13/20)、30.0％(6/20)화0(0/20).2조간생존기적차이유통계학의의(Log-rank검험x2=26.755,P ＜0.01).치료후2조탄인곤난정도적개선차이유통계학의의(t=2.885,P＜0.01).결론 동맥관주화료가전새미구전새술치료분문암가교단순관주화료술경쾌지축소종류、쾌속완해탄인곤난등증상,제고환자근기생존솔,개선생활질량,시일충유효적치료방법.
Objective To evaluate the short term curative effect of cardia cancer treated by intraarterial infusion chemotherapy combined with trisacry gelatin microspheres enbolization.Methods A prospective study was performed,39 patients with cardlia cancer pathologically confirmed were included into this study and then they were randomly assigned into two groups of group A and group B.Group A included 19 patients and the patients were treated by intra-arterial infusion chemotherapy combined with trisacryl gelatin microspheres embolization.Group B included 20 patients and treated by intra-arterial infusion chemotherapy only.Protocols of chemotherapy were Oxaliplatin (100-150 mg) combined with Doxifluridine (2000-2500 mg).During the interventional procedure,if the patients had hepatic metastasis,the hepatic metastasis were treated by intra-arterial chemoembolization.All of the patients underwent follow up by telephone or patients hospitalization.Statistical analysis was performed by x2 test,Kaplan-Meier and Log-rank test.Results All the patients were followed up 3-27 months.The median survival was 17.5 months,the 6-month,12-month and 18-month overall survival rates were 89.5％ (17/19),84.2％ (16/19) and 26.3％ (5/19)in group A,respectively.The median survival was 12.5 months,the 6-month,12-month and 18-month overall survival rates were 65.0％ (13/20),30.0％ (6/20)and 0(0/20)in group B,respectively.The median survival had statistically significant difference between group A and group B (Log-rank test,x2 =26.755,P ＜ 0.01).There were statistically significant difference of dysphagia improvement in group A and B after therapy(t =2.885,P ＜ 0.01).Conclusions Intra-arterial infusion chemotherapy combined with trisacryl gelatin microspheres enbolization can minificate the tumor promptly and improve disphagia in patients with cardia cancer,and also is an effective method which can prolong patent's survival period and improve quality of life.