雷替曲塞动脉灌注化疗分析（威客yyhf5）梁军，元龙陈，潘慧娟，钱鹰，徐丹，李敏无锡市惠山区人民医院肿瘤科，邮编214187，中国无锡市惠山区Abstract Objective: The aim of this study was to analysis raltitrexed by the safety and efficacy of intra-arterial infusion chemotherapy. Methods: Forty-seven cases in different parts of cancer patients, interventional methods, based on digital subtraction angiography (DSA) prompt, raltitrexed-based chemotherapy, the tumor nourish artery infusion chemotherapy. Patients with postoperative chemotherapy side effects and complications, and efficacy assessments. Results: Forty-seven patients, 2 patients had II–III degree of bone marrow suppression, the rate was 4.26%, 34 cases of I to II degree gastrointestinal reactions, 1 case of grade III gastrointestinal reactions, the incidence of 2.13%, and 1 case mild diarrhea. I degrees or more chemotherapy-related adverse reactions did not occur in this group of patients. All patients received at least 2 times arterial infusion chemotherapy, complete remission (CR) 3 cases, partial remission (PR) 11 cases, stable disease (SD) 17 cases, disease progression (PD) 6 cases, total effective rate of treatment 87.23%. Conclusion: Raltitrexed for intra-arterial chemotherapy is safe and effective. However, due to the small number of this group of patients, time is short, its safety, efficacy and long-term efficacy needs further observation and validation.【摘要】目的：本研究的目的是分析由动脉灌注的雷替曲塞化疗方法安全性和有效性。
方法：使用介入法，对47例癌症患者的不同部位，在数字减影血管造影（DSA）辅助下，使用以雷替曲塞为药物基础的肿瘤动脉灌注入化疗。
患者术后化疗的毒副作用和并发症疗效评估：四十七例患者中，2例出现Ⅱ〜Ⅲ度骨髓抑制，发生率为4.26％，出现34例Ⅰ〜Ⅱ度胃肠道反应，1例Ⅲ级胃肠道反应，发病率为％2.13，1例轻度腹泻。
在这组患者中没有出现1度以上化疗相关的不良反应。
所有患者均接受至少2次动脉灌注化疗，完全缓解（CR）3例，部分缓解（PR）11例，疾病稳定（SD）17例，疾病恶化（PD）6例，治疗总有效率达87.23％。
结论：雷替曲塞动脉灌注化疗是安全有效的。
然而，由于本组中病例少，时间短，其安全性，疗效和远期疗效有待进一步观察和验证。
Key words raltitrexed; transcatheter arterial chemo-infusion; security; validity关键词雷替曲塞;导管动脉化疗灌注;安全性;有效性Raltitrexed to thymine synthetase inhibitor, is quinazoline folate analogs, are cytotoxic drugs, primarily for the treatment of colorectal cancer. According to foreign literature, raltitrexed has also been used in clinical treatment of gastric cancer,pancreatic cancer, esophageal cancer, head and neck cancer and malignant pleural mesothelioma, etc [1]. Raltitrexed arterial infusion hemotherapy and abroad rarely reported, in July 2012 we have 2013 in June in 47 patients with malignant tumors, the use of raltitrexed arterial infusion chemotherapy, the patient tolerated, and achieved satisfactory results.雷替曲塞为胸腺嘧啶合成酶抑制剂，是喹唑啉叶酸类似物，是细胞毒性药物，主要用于大肠癌的治疗。
据国外文献报道，雷替曲塞也已用于临床治疗胃癌，胰腺癌，食道癌，头颈部癌和恶性胸膜间皮瘤等[1]。
雷替曲塞动脉灌注化疗在国外鲜有报道，2012年7月至2013年六月我们使用雷替曲塞动脉灌注化疗治疗47例恶性肿瘤，观察耐受性，并取得了满意的效果。
Materials and methodsStudyForty-seven patients in 32 males and 15 females, aged 47 to 81 years, mean age 58 years. Lung cancer 18 cases, esophageal cancer 10 cases, gastric cancer 3 cases, rectal cancer 3 cases, liver cancer 11 cases, breast cancer 2 cases. All patients were pathologically confirmed as malignant. TNM stage III – IV period. KPS scores 60 to 90 min. Preoperative WBC > 4.5 ×109/L, hemoglobin> 100 g/L, platelets > 97 ×109/L, albumin > 32 g/L, liver and kidney function, electrolytes, coagulation, electrocardiogram was normal.材料和方法研究四十七名患者中男32例，女15例，年龄47〜81岁，平均年龄58岁。
肺癌18例，食管癌10例，胃癌3例，直肠癌3例，肝癌11例，乳腺癌2例。
所有患者均经病理证实为恶性。
TNM分期III - IV期。
KPS评分60〜90。
术前WBC>4.5×109 / L，血红蛋白>100克/ L，血小板>97×109 / L，白蛋白>32克/ L，肝，肾功能，电解质，凝血功能，心电图，正常。
TreatmentSeldinger technique, took the right or left femoral arteryat the groin puncture site, local skin disinfection, localanesthesia into the femoral artery puncture 5F cathetersheath, used 4F or 5F catheter, the catheter was insertedinto the tumor selectively nourish blood vessels, lungchose bronchial artery (Fig. 1 and 2), esophageal canceresophageal branches selected bronchial artery, esophagus artery and left gastric artery, left gastric artery and gastric selected gastroduodenal artery, superior mesenteric artery and rectal selected iliac artery, left hepatic carcinoma choice artery, internal thoracic artery and breast selected lateral thoracic artery. Aftersuccessful intubation nonionic contrast agent (Ioversol) 8–15 mL, with 3–6 mL/s speed injection line target arterial digital subtraction angiography (DSA). The tumor vascular supply and dyeing, and to observe whether the dangerous branch vessels, arteriovenous fistula, bleeding. For dangerous branch (intercostal arteries, spinal artery) and arterial tortuosity walk the line of cases, the use of ultra-3F microcatheter inserted into the target vessel selection, tried to avoid the risk of arterial branches and normal tissue, reducing the incidence of complications and normal tissue damage. After the tumor target vessel, slowly injected through the catheter diluted anticancer drugs (Table 1).治疗使用塞尔丁格法，在腹股沟右侧或左侧股动脉部位穿刺，局部皮肤消毒，局麻使用5F导管鞘进行股动脉穿刺，用4F或5F导管插入到肿瘤滋养血管中，肺癌患者导管插入到支气管动脉（图1和2），食管癌患者导管插入到食管支气管动脉，食管动脉和胃左动脉，胃癌患者导管插入到胃左动脉，肠癌患者导管插入到十二指肠动脉，肠系膜上动脉，髂内动脉，左肝癌患者导管插入到胸廓内动脉，乳腺癌患者导管插入到胸外侧动脉。