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目的 研究直肠癌病人术前直肠粘膜下植入 5 -FU缓释剂后 ,癌组织病理形态学、癌细胞凋亡和增殖的变化。方法 对 2 5例直肠癌拟手术者采用配对设计分为两组 :Ⅰ组 (n =13)为植药组 ,每例术前直肠粘膜下植入 5 -FU缓释剂 5 0 0mg。Ⅱ组 (n =12 )为非植药组 ,采用常规术前准备。两组病人均在术前 (植药前 )及术后立即取肿瘤组织。观察癌组织病理形态和识别凋亡癌细胞、增殖细胞核抗原表达的变化。数据采用SPSS10 1软件进行统计学处理。结果 Ⅰ组中癌组织出现化疗效应的病理形态学改变 ;癌细胞凋亡指数 (AI)化疗后(3 6 2 3± 1 2 35 )较化疗前 (1 2 0 0± 0 398)明显增加 ,P <0 0 5 ;癌细胞的增殖指数 (PI)化疗后 (46 6 2± 7 2 2 )较化疗前 (5 6 85± 6 4 8)明显降低 ,P <0 0 1。而Ⅱ组手术前后病理形态学无变化 ,癌细胞AI、PI无明显改变。全组未发现毒副作用。结论 直肠粘膜下植入 5 -FU缓释剂是直肠癌术前区域性化疗的最佳途径之一 ,可望提高直肠癌根治术后的疗效
Objective To study the changes of histopathology, apoptosis and proliferation of cancer cells in patients with rectal cancer after preoperative submucosal implantation of 5-FU sustained-release agent. Methods Twenty-five patients with rectal cancer undergoing surgery were divided into two groups according to the paired design: group Ⅰ (n = 13) was treated with phytomedicine group, and 5 cases of 5-FU sustained-release agent were implanted subtotal preoperatively. Group Ⅱ (n = 12) were non-drug-treated group, which were routinely preoperatively prepared. Two groups of patients in the preoperative (pre-treatment) and immediately after the tumor tissue. The pathological changes of the cancer tissues were observed, and the changes of the expression of proliferating cell nuclear antigen and apoptotic cancer cells were identified. Data were analyzed by SPSS10 1 software. Results The histopathological changes of the cancer tissue in group Ⅰ were observed. The apoptosis index (AI) of cancer cells (3623 ± 1235) after chemotherapy was significantly higher than that before chemotherapy (1220 ± 398) P <0.05. The proliferation index (PI) of cancer cells was significantly lower after chemotherapy (46 6 2 ± 7 2 2) than before chemotherapy (5 6 85 ± 6 48), P <0.01. The histopathology of group Ⅱ before and after surgery had no change, and the AI and PI of cancer cells did not change significantly. The whole group did not find any side effects. Conclusion Rectal submucosal implantation of 5-FU sustained-release agent is one of the best ways to preoperative regional chemotherapy for rectal cancer, which is expected to improve the curative effect after radical operation of rectal cancer