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目的 探讨术前区域性动脉灌注介入化疗在局部进展期胰腺癌治疗中的作用。方法 1999～ 2 0 0 2年 ,94例局部进展期胰腺癌病人随机分为术前介入化疗组 (6 4例 )和未介入化疗组 (30例 ) ,比较两组病人手术切除率的差异 ,观察介入化疗前后肿瘤大小的改变、疼痛缓解率、血清肿瘤标志物的变化和不良反应程度 ,并通过免疫组化和基因芯片技术分析术前介入化疗对胰腺癌肿瘤相关基因表达的影响。结果 术前介入化疗组和未介入化疗组的手术切除率分别为 4 6 8%和 2 3 3% (P <0 0 5 ) ;术前介入化疗组部分甲基化相关基因 (MBD1、E2F5和Rb)的表达明显被抑制 ,细胞凋亡比值 (bax/bcl 2 )明显增加 ,血清肿瘤标志物水平显著降低 ,病人疼痛明显缓解 (P<0 0 5 )。结论 术前介入化疗能明显抑制胰腺癌肿瘤细胞生长和促进肿瘤细胞凋亡 ,有助于提高手术切除率和改善病人疾病相关症状 ,是胰腺癌综合治疗的有效措施之一。
Objective To investigate the effect of preoperative regional arterial infusion chemotherapy in the treatment of locally advanced pancreatic cancer. Methods From 1994 to 2002, 94 patients with locally advanced pancreatic cancer were randomly divided into preoperative interventional chemotherapy group (64 cases) and non-intervention chemotherapy group (30 cases). The difference of surgical resection rate between the two groups was compared, The changes of tumor size, pain relief rate, changes of serum tumor markers and the degree of adverse reactions before and after interventional chemotherapy were observed. The effects of preoperative interventional chemotherapy on the expression of tumor-related genes in pancreatic cancer were analyzed by immunohistochemistry and microarray. Results The surgical resection rates of preoperative intervention group and non-intervention group were respectively 46.8% and 23.3% (P <0.05). The methylation-related genes (MBD1, E2F5 and Rb) was significantly inhibited. The ratio of apoptotic cells (bax / bcl2) was significantly increased. The level of serum tumor markers was significantly decreased, and the pain of patients was relieved (P <0.05). Conclusion Preoperative chemotherapy can significantly inhibit the growth of pancreatic cancer cells and promote apoptosis of tumor cells, which can help to improve the resection rate and improve the disease-related symptoms of patients. It is one of the effective measures for the comprehensive treatment of pancreatic cancer.