摘要
目的探讨胃癌术前选择性动脉插管化疗的作用机制．方法观察４０例胃癌患者术前经腹腔动脉或胃左动脉插管化疗后癌组织的血管形态和组织病理学变化，并与４０例未化疗者进行对比．化疗方案为５ＦＵ５００ｍｇ／ｍ２～７５０ｍｇ／ｍ２，ｅｐｉｒｕｂｉｃｉｎ４０ｍｇ／ｍ２和ＭＭＣ１０ｍｇ／ｍ２．结果治疗组８７５％（３５／４０）出现不同程度的坏死，以中－重度为主，（６０％），对照组４２５％（１７／４０）表现出轻度坏死．治疗组变性坏死８２５％（３３／４０）发生在血管周围，对照组肿瘤坏死发生在远离血管的肿瘤浅表层；介入治疗引起的坏死与肿瘤自然坏死的区别是，坏死多沿血管轴发生，在肿瘤实质部分出现大片多灶性凝固性坏死，有的呈梗死表现．术前介入治疗对血管的影响主要表现在血管壁的炎性水肿（９５％），血管内膜增厚（９０％），血栓形成（７７５％）．结论介入治疗可以通过高浓度的化疗药物产生小血管和间质炎症，使管腔狭窄或形成血栓，影响肿瘤血供，产生病理性坏死，达到一定的治疗作用．
AbstractAIM To study the relationship between vascular changes and cancer tissue necrosis in 40 patients with gastric cancer treated with preoperative transcatheter arterial chemotherapy (TAC).METHODS Eighty gastric cancer patients treated with (n=40) or without (n=40) TAC were enrolled. Radical surgery was undertaken in all of the patients. In TAC group selective arterial infusion of anticancer drugs (5fluorouracil 500mg/m2-750mg/m2, mitomycin (10mg/m2 and epirubicin 40mg/m2) were given preoperatively. Pathologic examinations were undertaken after surgery to study the relationship between vascular changes and cancer tissue necrosis.RESULTS The rate of tumor necrosis was significantly increased in TAC group as compared with control (875% vs 425%). The multiple necrotic foci and infarction around the vessel were found in the center of the tumor tissue in TAC group (33/40). However, the tumor natural necrosis in patients without TAC group could only be found in the peripheral zone of the tumor which was far from the feeding vessel (17/40). There were severe inflammation and edema in the vessels and stroma after TAC. The thickened vascular epithelial membrane and thromboarteriolitis resulted in obliteration of the vessels and reduction of the blood supplying in the tumor.CONCLUSION The therapeutic effect of TAC may relate partly to the severe ischemic and necrosis of the lesion caused by the pathological changes of the supplying vessels in the tumor after TAC.
