胃左动脉联合食管固有动脉化疗栓塞治疗中晚期贲门癌的疗效
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摘要
目的观察分析胃左动脉联合食管固有动脉化疗栓塞治疗中晚期贲门癌临床价值。方法回顾性分析自2015年3月至2017年12月收治的52例中晚期贲门癌患者,其中25例采用贲门癌胃左动脉灌注化疗药物并栓塞(称常规组),联合组27例在常规组基础上追加食管固有动脉灌注化疗栓塞。术后定期复查上消化道造影、上腹部CT等。采用Kaplan-Meier法计算生存时间,Log-rank检验比较2组患者的生存曲线。结果患者随访3～27个月,术后常规组总缓解率达48%,联合组总缓解率达77.8%,吞咽困难改善程度联合组优于常规组,差异有统计学意义(P<0.05)。常规组中位生存期为12个月,6、12、18、24个月生存率分别为76%(19/25)、48%(12/25)、16%(4/25)、0,联合组中位生存期为17个月,6、12、18、24个月生存率分别为92.6%(25/27)、77.8%(21/27)、37%(10/27)、7.4%(2/27),生存曲线的差异有统计学意义(Log-rank检验,χ~2=5.973,P<0.05)。结论胃左动脉联合食管固有动脉灌注化疗栓塞治疗中晚期贲门癌较单纯胃左动脉灌注化疗栓塞能更有效地控制肿瘤病灶发展、改善患者症状,延长生存期,在临床治疗中有一定价值。
Objective To analyze the clinical value of additional proper esophageal artery chemoembolization in treating advanced cardiac carcinomas. Methods The clinical data of 52 patients with advanced cardiac carcinoma, who were admitted to authors' hospital during the period from March 2015 to December 2017 to receive treatment, were retrospectively analyzed. The patients were divided into routine group(n=25, receiving left gastric artery infusion of chemotherapeutic drugs and embolization) and combination group(n=27, receiving additional proper esophageal artery chemoembolization on the basis of the treatment used in the routine group). After the treatment, upper gastrointestinal radiography, upper abdominal CT scan, etc. were periodically reexamined. Using Kaplan-Meier method to calculate the survival time, and Log-rank test was used to compare the survival curve between the two groups. Results All the patients were followed up for 3-27 months. The postoperative overall remission rates in the routine group and the combination group were 48% and 77.8% respectively. The improvement degree of dysphagia in the combination group was much better than that in the routine group, the difference between the two groups was statistically significant(P<0.05). In the routine group, the median survival was 12 months, and the 6-, 12-,18-, and 24-month overall survival rates were 76%(19/25), 48%(12/25), 16%(4/25) and 0%(0/25)respectively. In the combination group, the median survival was 17 months, and the 6-, 12-, 18-and 24-month overall survival rates were 92.6%(25/27), 77.8%(21/27), 37%(10/27) and 7.4%(2/27) respectively.The difference in survival curve between the two groups was statistically significant(using Log-rank test, χ~2=5.973, P<0.05). Conclusion For the treatment of advanced cardiac carcinomas, left gastric artery infusion chemoembolization combined with proper esophageal artery chemoembolization is superior to simple left gastric artery infusion chemoembolization in more effectively controlling the development of tumor lesions,improving the symptoms of patients, and prolonging the survival period. This therapy has certain value in clinical treatment.
Objective To analyze the clinical value of additional proper esophageal artery chemoembolization in treating advanced cardiac carcinomas. Methods The clinical data of 52 patients with advanced cardiac carcinoma, who were admitted to authors' hospital during the period from March 2015 to December 2017 to receive treatment, were retrospectively analyzed. The patients were divided into routine group(n=25, receiving left gastric artery infusion of chemotherapeutic drugs and embolization) and combination group(n=27, receiving additional proper esophageal artery chemoembolization on the basis of the treatment used in the routine group). After the treatment, upper gastrointestinal radiography, upper abdominal CT scan, etc. were periodically reexamined. Using Kaplan-Meier method to calculate the survival time, and Log-rank test was used to compare the survival curve between the two groups. Results All the patients were followed up for 3-27 months. The postoperative overall remission rates in the routine group and the combination group were 48% and 77.8% respectively. The improvement degree of dysphagia in the combination group was much better than that in the routine group, the difference between the two groups was statistically significant(P<0.05). In the routine group, the median survival was 12 months, and the 6-, 12-,18-, and 24-month overall survival rates were 76%(19/25), 48%(12/25), 16%(4/25) and 0%(0/25)respectively. In the combination group, the median survival was 17 months, and the 6-, 12-, 18-and 24-month overall survival rates were 92.6%(25/27), 77.8%(21/27), 37%(10/27) and 7.4%(2/27) respectively.The difference in survival curve between the two groups was statistically significant(using Log-rank test, χ~2=5.973, P<0.05). Conclusion For the treatment of advanced cardiac carcinomas, left gastric artery infusion chemoembolization combined with proper esophageal artery chemoembolization is superior to simple left gastric artery infusion chemoembolization in more effectively controlling the development of tumor lesions,improving the symptoms of patients, and prolonging the survival period. This therapy has certain value in clinical treatment.
引文
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[8]蔺红丽,宋昕,张朋,等.青中老年贲门癌患者生存期影响因素分析[J].肿瘤防治研究,2014,41:243-247.
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[10]胡鸿涛,黎海亮,郭晨阳,等.动脉灌注化疗加栓塞微球栓塞治疗中晚期贲门癌的近期疗效观察[J].中华放射学杂志,2013,47:1115-1119.
[11]刘灿均,王兴华,李立.术前介入化疗及栓塞对贲门癌的治疗价值[J].介入放射学杂志,2003,12:355-356.
[12]焦德超,庞晨光,韩新巍,等.可携带125I粒子的鼻饲营养管研制及初步临床使用[J].介入放射学杂志,2017,26:1004-1008.
[2]骆明莲,程宏文,王永兵,等.奥沙利铂联合替吉奥同步三维适形放疗治疗中晚期贲门癌的疗效观察[J].现代肿瘤医学,2015,23:1997-2000.
[3]李玉红,杨宏,艾建中,等.胃左动脉灌注化疗/栓塞治疗晚期贲门癌70例[J].世界华人消化杂志,2013,22:2202-2205.
[4]Tao HQ,Zou SC.Effect of preoperative regional artery chemotherapy on proliferation and apoptosis of gastric carcinoma cells[J].World J Gastroenterol,2002,8:451-454.
[5]杨宝玉,张祖平.食道癌供血动脉造影及灌注化疗初步探讨[J].医学美学美容·中旬刊,2014,6:460.
[6]姬统理,王义清,闵婕.介入化疗治疗中下段食管癌60例[J].第四军医大学学报,2001,22:2060.
[7]任医民,伍筱梅,钱元新,等.食管固有动脉作为非支气管性体动脉参与咯血的介入诊断与治疗[J].介入放射学杂志,2013,22:734-737.
[8]蔺红丽,宋昕,张朋,等.青中老年贲门癌患者生存期影响因素分析[J].肿瘤防治研究,2014,41:243-247.
[9]张月明,王瑞刚,王贵齐.早期贲门癌内镜下诊断与治疗[J].中国医学前沿杂志·电子版,2017,9:23-28.
[10]胡鸿涛,黎海亮,郭晨阳,等.动脉灌注化疗加栓塞微球栓塞治疗中晚期贲门癌的近期疗效观察[J].中华放射学杂志,2013,47:1115-1119.
[11]刘灿均,王兴华,李立.术前介入化疗及栓塞对贲门癌的治疗价值[J].介入放射学杂志,2003,12:355-356.
[12]焦德超,庞晨光,韩新巍,等.可携带125I粒子的鼻饲营养管研制及初步临床使用[J].介入放射学杂志,2017,26:1004-1008.