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目的研究经左锁骨下动脉药盒灌注吉西他滨治疗晚期胰腺癌的有效性和安全性。方法回顾性分析80例经左锁骨下动脉药盒介入治疗的晚期胰腺癌患者临床资料,分别评价其临床受益反应、肿瘤客观疗效、OS,以及药物的毒副反应和手术并发症。用Spss17.0软件对相关的影响因素进行单因素及多因素分析。结果经介入治疗患者临床受益反应率为56%(45/80),主要表现为疼痛的减轻及止痛药物用量的减少。80例患者可评价62例,其中部分缓解(PR)9例(11.25%),稳定(SD)27例(33.75%),进展(PD)16例(20.00%),治疗客观反应率为11.25%,疾病控制率为45%。中位生存期160 d(95%CI:98.76~221.24),1年生存率23.3%。单因素分析结果表明,梗阻性黄疸、ECOG评分、化疗次数、转移、糖尿病与晚期胰腺癌患者的生存明显相关(P<0.05)。Cox比例风险回归模型多因素分析结果表明,梗阻性黄疸、ECOG评分、化疗次数及转移是影响晚期胰腺癌患者预后的独立因素。药物毒副反应主要表现为轻度骨髓抑制及恶心、呕吐,出现骨髓抑制的中位时间为10 d。手术并发症主要为药盒导管的堵塞[2.5%(2/80)]。结论左锁骨下动脉药盒介入化疗能明显增加患者的临床受益反应,提高患者生活质量,减少全身毒副反应,是治疗晚期胰腺癌安全、有效的方法。
Objective To study the efficacy and safety of gemcitabine in the treatment of advanced pancreatic cancer by left subclavian arterial injection. Methods The clinical data of 80 patients with advanced pancreatic cancer who underwent interventional treatment with left subclavian arterial pill were retrospectively analyzed. Their clinical benefit, objective tumor response, OS, toxicity and complications were evaluated respectively. Using Spss17.0 software to univariate and multivariate analysis of related factors. Results The clinical benefit response rate of interventional therapy patients was 56% (45/80), mainly manifested as the reduction of pain and the decrease of the amount of analgesic drugs. Eighty patients were evaluated in 62 cases, of which 9 (11.25%) were partial remission (PR), 27 (33.75%) were stable (SD) and 16 (20.00%) were PD. The objective response rate was 11.25% , Disease control rate was 45%. The median survival time was 160 days (95% CI: 98.76 ~ 221.24) and 1-year survival rate was 23.3%. Univariate analysis showed that the obstructive jaundice, ECOG score, the number of chemotherapy, metastasis and diabetes were significantly correlated with the survival of patients with advanced pancreatic cancer (P <0.05). Cox proportional hazards regression model multivariate analysis showed that obstructive jaundice, ECOG score, the number of chemotherapy and metastasis were independent prognostic factors in patients with advanced pancreatic cancer. Drug side effects mainly showed mild myelosuppression and nausea, vomiting, bone marrow suppression occurred in the median time of 10 d. The main complication was the blockage of the cartridge catheter [2.5% (2/80)]. Conclusions Interventional chemotherapy with left subclavian cartridge can significantly increase the clinical benefit response of patients, improve the quality of life of patients and reduce the systemic side effects. It is a safe and effective method for the treatment of advanced pancreatic cancer.