【摘要】：目的淋巴結轉移是影響食管癌患者預后的主要因素。淋巴結化療(lymph node chemotherapy,LNC)采用吸附了化療藥物的載體可被淋巴結中巨噬細胞吞噬的原理實現(xiàn)淋巴結的"靶向化療"。本研究探討LNC在食管癌術中的運用價值,篩選LNC中的較優(yōu)藥物,并與同期靜脈化療對比。方法選取2013-01-21-2013-10-23四川大學華西醫(yī)院胸外科接受食管癌治療的患者92例,采取單中心前瞻性半隨機單盲對照研究。其中紫杉醇-納米炭淋巴結化療組(LNC by paclitaxel-carbon nanoparticles,LNP)、氟尿嘧啶-納米炭淋巴結化療組(LNC by fluorouracil-carbon nanoparticles,LNF)各41例,按相應藥物接受術中LNC;氟尿嘧啶靜脈化療組(venous chemotherapy by fluorouracil,VF)10例,接受術中氟尿嘧啶靜脈化療。光鏡下觀察注射部位及淋巴結內藥物分布,比較各組淋巴結、血清相應藥物濃度。結果光鏡下吸附了化療藥物的納米炭未引起局部組織炎性細胞浸潤及壞死,并可聚集于淋巴結皮質。LNP組淋巴結中紫杉醇藥物濃度為2.16(3.25),高于血清濃度0.00(0.00),Z=-5.579,P0.01。LNF組淋巴結中氟尿嘧啶藥物濃度為0.44(1.07),也高于血清濃度0.00(0.31),Z=-3.069,P0.01。而VF組淋巴結藥物濃度0.11(0.26)與血藥濃度0.00(0.15)的差異無統(tǒng)計學意義,Z=-0.135,P=0.893。LNF組淋巴結內藥物濃度0.44(1.07)比VF組0.11(0.26)高,H=94.500,P0.01。LNP組淋巴結內藥物濃度2.16(3.25)高于LNF組0.44(1.07),H=351.000,P0.01,血清藥物濃度0.00(0.00)則低于LNF組0.00(0.31),H=577.000,P0.01。結論在食管癌術中,LNC可安全、有效地使化療藥物靶向進入并停留于淋巴結,在淋巴結轉移療效上可能優(yōu)于同期靜脈化療。實施LNC時,優(yōu)選對載體親和力高的藥物。
[Abstract]:Objective lymph node metastasis is a major prognostic factor in patients with esophageal cancer. Lymph node chemotherapeutic (lymph node chemotherapy,LNC (lymph node chemotherapy,LNC) uses the principle that the carrier of chemotherapeutic drugs can be phagocytized by macrophages in lymph nodes to realize the "targeted chemotherapy" of lymph nodes. The purpose of this study was to investigate the application value of LNC in esophageal cancer operation and to screen the better drugs in LNC, and to compare with intravenous chemotherapy at the same time. Methods Ninety-two patients with esophageal cancer received thoracic surgery in West China Hospital of Sichuan University, 2013-01-21-2013-10-23. A prospective, single-center, semi-randomized, single-blind controlled study was carried out. There were 41 cases of paclitaxel-nano-carbon lymph node chemotherapy group (LNC by paclitaxel-carbon nanoparticles,LNP) and 41 cases of fluorouracil nano-carbon lymph node chemotherapy group (LNC by fluorouracil-carbon nanoparticles,LNF). The patients received intraoperative LNC; according to the corresponding drugs. Ten patients in fluorouracil intravenous chemotherapy group (venous chemotherapy by fluorouracil,VF) received intraoperative fluorouracil intravenous chemotherapy. The distribution of drugs in the injection site and lymph nodes were observed under light microscope, and the corresponding drug concentrations in the lymph nodes and serum were compared. Results carbon nanoparticles adsorbed chemotherapeutic drugs under light microscope did not cause infiltration and necrosis of local inflammatory cells, and could be clustered in lymph node cortex. The concentration of paclitaxel in lymph nodes of LNP group was 2.16 (3.25). The concentration of fluorouracil was 0.44 (1.07) in the lymph nodes of ZHV 5.579 P0.01.LNF group, but also higher than that of 0.00 (0.31) in serum. In VF group, there was no significant difference in lymph node drug concentration between 0.11 (0.26) and 0.00 (0.15). The drug concentration in lymph nodes of P=0.893.LNF group was 0.44 (1.07) higher than that of VF group 0.11 (0.26). The intralymph node drug concentration of H94.500g P0.01.LNP group was 2.16 (3.25) higher than that of LNF group 0.44 (1.07). The serum drug concentration (0.00) was lower than that in LNF group (0.00 (0.31), P 0.01). Conclusion during esophageal cancer operation, LNC is safe and effective to make chemotherapeutic drugs enter and stay in lymph nodes, which may be superior to intravenous chemotherapy in lymph node metastasis. When implementing LNC, the drug with high affinity to the carrier was selected.
【作者單位】： 四川大學華西醫(yī)院胸外科;
【分類號】：R735.1

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