【作者】 李文佳；

【导师】 续哲莉； 邢华；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 乳腺癌是女性最常见的恶性肿瘤之一，近年来我国乳腺癌发病率逐年上升，且发病年龄有年轻化趋势。由于医疗整体水平和人口素质的差别，在我国乳腺癌患者中，局部晚期乳腺癌患者占很大比例，此时由于肿块巨大，乳房皮肤受累面积广，腋窝淋巴结融合成团或腋血管受侵，常已无法一期行根治性切除，须行新辅助化疗。新辅助化疗可以使肿瘤明显缩小，降低肿瘤分期，并可改善区域淋巴结情况，使不可手术的局部晚期乳腺癌患者获得二期手术治疗的机会，且有助于早期杀灭亚临床转移灶，并可预测机体对化疗药物的敏感性。新辅助化疗有两种途径，一种是全身静脉化疗，另一种是经动脉灌注化疗。近年来随着介入放射学的发展和Seldinger技术的广泛应用，动脉灌注化疗已经变得十分简便、安全，目前Seldinger技术已成为动脉灌注化疗的标准方法，广泛应用于肝、肺、头颈、四肢等实体肿瘤的综合治疗之中。本文对吉林大学中日联谊医院乳腺外科2009年11月-2011年11月收治的58例Ⅲ期乳腺癌患者随机分为两组：经锁骨下动脉灌注组（动脉组）和全身静脉化疗组（静脉组），选择以吡柔比星为主的联合化疗方案，对比两组患者行新辅助化疗后的临床疗效及毒副作用，结果提示动脉组较静脉组具有更高的近期疗效和更低的全身毒副反应（p<0.05），从而证实动脉灌注化疗是一种更切实有效的晚期乳腺癌新辅助化疗方法。更多还原

【Abstract】 Objective:To study the best way of neoadjuvant chemotherapy in locallyadvanced breast cancer.Methods：Selecting58cases of breast cancer（stageⅢ） patients treatedin breast surgery，china-japan union hospital of jilin university，in November2009-November2011.All patients were randomly divided into two groups,including27cases of subclavian artery infusion groupe and31cases ofsystemic intravenous chemotherapy group.Both groupes took neoadjuvantchemotherapy mainly containing Pirarubicin.The chemotherapy drugs and thedoses were for cyclophosphamide500mg/m2, Pirarubicin40mg/m2，5-Fu500mg/m2.The artery group took subclavian artery perfusion chemotherapy bySeldinger’s technique following percutaneous femoral artery puncture, fourweeks as a course of treatment.The vein group was performanced by Peripheralintravenous drip only once，three weeks as a course of treatment, mean2to4course of treatment.After chemotherapy observing the clinical efficacy and theside reaction of two groups, doing a comparative study.Results: The artery group was generally performanced preoperativechemotherapy for1to2courses of treatment，the vein group generally was for2to4courses of treatment.Though observation at two weeks afterchemotherapy，the tumor diameter of artery group reduced from7.08±1.34cmto3.83±1.22cm， while the tumor diameter of vein group reduced from7.15±1.41cm to5.19±1.19cm.The Clinical response rate in artery group was96.30%，while the vein group was41.94%.There was statistic difference between the two groups(P<0.05).Through observation before the operation，theClinical response rate in artery group was96.30%，while the vein group was90.32%，there was no statistic difference between the two groups(P>0.05). Thetime interval from Chemotherapy to operation in artery group was15.5士5.60days，while the vein group was60.10士16.34days，the former was obviouslyshorter than the latter. About the side effects of Chemotherapy，the bonemarrow inhibition and gastrointestinal reaction rate in artery group wassignificantly lower than the vein group，there was statistic difference betweenthe two groups(P<0.05).Conclusion: Subclavian artery infusion with Pirarubicin is a practical andeffective method of neoadjuvant chemotherapy for locally advanced breastcancer, compared with systemic venous chemotherapy, it can improve thesuccess rate of operation and the resection rate in locally advanced breastcancer patients, reduce systemic adverse reaction，early remove the tumor,prevent metastasis and recurrence.更多还原