Colorectal cancer originates from the epithelial cells of the large intestine mucosa and is classified into cecal cancer, colon cancer, and rectal cancer. Benign tumors are relatively rare in colon and rectal tumors. Malignant tumors, including colon cancer and rectal cancer, are common in middle-aged and elderly people, and rectal cancer is the most common. Early symptoms are not obvious, followed by changes in bowel habits and stool characteristics, abdominal pain, abdominal masses, and systemic symptoms such as anemia, weight loss, jaundice, ascites, and fever. Local diarrhea or bowel obstruction or increased stool frequency, thinner stools and blood in the stool. In the late stage, there are intestinal bleeding, intestinal perforation, peritonitis, and rectal bladder fistula. Colon tumor: (carcinomaofrectum) is a common malignant tumor in the gastrointestinal tract, the incidence is second only to gastric and esophageal cancer, is the most common part of colorectal cancer (accounting for about 60%). The vast majority of patients are over 40 years old, and about 15% are under 30 years old. Men are more common, the ratio of men to women is 2-3:1. According to clinical observations, it has been found that part of intestinal cancer occurs on the basis of rectal polyps or schistosomiasis; chronic inflammation of the intestine, and some can induce cancer; high-fat and high-protein diets increase the secretion of bile acid, which is caused by intestinal anaerobic bacteria Decomposed into unsaturated polycyclic hydrocarbons, it can also cause cancer. Be wary of changes in bowel habits, which are the earliest and most common symptoms of rectal cancer. Due to the stimulation of the cancer, the patient may have an increase in the number of bowel movements for no obvious reason or constipation and diarrhea alternately in a short period of time, and there will be a feeling of incomplete defecation. As the course of the disease progresses and the focus increases, cancer can block the rectal outlet, causing symptoms such as constipation, thinning or deformation of stool, and abdominal distension; stool characteristics change. Stool thinning, blood and mucus in the stool. 80% to 90% of rectal cancer may have blood in the stool, the blood is bright red or dark red, often mixed with mucus or pus. Sometimes shed tumor tissue can be seen in the stool, but this is often not the early stage; see a doctor early. Once the patient finds the above symptoms, he should go to the hospital for examination immediately. When seeing the doctor, be careful not to easily believe the conclusion that the doctor has not performed the examination, such as hemorrhoids or bacillary dysentery. If the doctor does not request an examination, the patient may as well ask for it. Generally speaking, digital rectal examination can find more than 75% of rectal cancers, and simple sigmoidoscopy can find almost all rectal cancers; take it seriously. Many patients may be ashamed of the examination or afraid of the pain caused by the examination. After the doctor has issued the examination sheet, they will not do the examination with the sheet, which delays the opportunity for early detection. Such cases are not uncommon in clinical practice.
Colorectal cancer has an insidious onset, and only positive fecal occult blood is seen in the early stage. It gradually becomes bloody stools, dysentery-like pus and bloody stools, tenesmus, sometimes intractable constipation, stool shape becomes thin, or mushy stool, or diarrhea and constipation alternate, these changes become colon cancer Outstanding performance. Patients often have different degrees of abdominal pain, often with erosions, necrosis, and secondary infections. If they occur on the right side, they will have dull pain in the right abdomen, and sometimes postprandial abdominal pain. Left colon cancer often complicates intestinal obstruction, sometimes abdominal cramps, bloating, and hyperintestinal sounds. Abdominal masses are more common in the right abdomen. It is one of the manifestations of right colon cancer. It indicates that it has reached the middle and advanced stages. The surface of the mass may have nodules, which can generally be pushed, but it is fixed when the tumor is advanced, and there may be tenderness when combined with infection. Patients with colon cancer may have progressive anemia, low fever, progressive weight loss, cachexia, hepatomegaly, edema, jaundice, and ascites.
1. The clinical manifestations are: early symptoms are not obvious, and then:
(1) Blood in the stool.
(2) Pus and blood in the stool and mucus and blood in the stool.
(3). Changes in bowel habits, including constipation, diarrhea, or alternating between the two, incomplete defecation, etc.
(4) The shape of stool changes.
(5). Abdominal pain, abdominal discomfort, abdominal mass, etc.
In the late stage, there are intestinal bleeding, intestinal perforation, peritonitis and rectal bladder fistula.
Two precancerous lesions:
(1). Adenoma: Adenoma is a precancerous lesion that has been recognized. Common symptoms include blood in the stool, changes in bowel habits, prolapse of the tumor outside the anus, and abdominal pain. A disposable sigmoid colon microscope should be used for early diagnosis and surgical resection as soon as possible.
(2). Chronic ulcerative colitis: The main symptoms are blood in the stool, increased bowel movements, and abdominal pain.
(3). Others: A. Systemic diseases: such as blood system diseases. B. Anal injury, etc. In short, blood in the stool should be checked in a regular hospital in time to exclude other diseases, so as not to delay the condition. In general, patients with stool bleeding should be highly vigilant clinically. Do not diagnose "dysentery" or "internal hemorrhoids" lightly. Further examinations must be performed to rule out the possibility of cancer. For the early diagnosis of rectal cancer, we must pay attention to the application of digital rectal examination, proctoscope or sigmoidoscopy.
3. Digital rectal examination Approximately 90% of rectal cancers, especially lower rectal cancer, can be found only by digital examination. However, there are still some doctors who do not perform this routine examination on patients with suspected rectal cancer, which delays diagnosis and treatment. In fact, this diagnosis method is simple and feasible. After digital rectal examination, the size and degree of infiltration of the palpable mass can also be judged, whether it is fixed, whether there is an implanted mass outside the intestinal wall and pelvic cavity.
Four-rectoscopy or sigmoidoscopy should be performed after digital rectal examination. The diagnosis should be assisted under direct vision. Observe the shape of the mass, the upper and lower edges and the distance from the anal edge, and take the mass tissue for pathological biopsy to confirm The nature of the mass and its degree of differentiation. The cancer is located in the middle and upper part of the rectum and cannot be touched by the fingers. Sigmoidoscopy is a better method.
5. Barium enema and fiber colonoscopy are not very helpful in the diagnosis of rectal cancer, so they are not listed as routine examinations and are only used to rule out multiple colorectal tumors. But it is a better method to check colon tumors.
3. Optimal choice of treatment methods and analysis of curative effect
Surgical treatment is currently the main method of treating colon and rectal tumors, and it is also the only possible cure for advanced colon and rectal tumors. Therefore, a positive attitude should be adopted in the surgical treatment of colon and rectal tumors, and laparotomy should be performed as long as the patient's general condition allows no clear distant metastasis.
A variety of surgical options
(1) Radical resection is also called curative resection.
(2). Palliative resection There are also different opinions on palliative resection. One opinion is that palliative resection can only relieve obstruction, bleeding, and pain to relieve symptoms, but cannot prolong life. Therefore, if the cancer can not be cured by laparotomy, the resection operation should be abandoned if there is no such complications. Most people believe that many patients with colon and rectal tumors who are considered to be palliative resections survive more than 5 years after surgery, and even the 5-year survival rate can reach about 11%. Therefore, a positive attitude should be taken towards cancer resection, not to mention a simple palliative resection of some radically curable cases, which will make some patients lose the chance of cure. Therefore, even if there has been a metastasis beyond the scope of radical resection, as long as the patient's general condition permits, when the local cancer may be resected, palliative resection should still be actively sought.
(3) Short-circuit surgery If the cancer cannot be removed and there is obstruction, an anastomosis can be used to relieve the obstruction, so that the patient can eat to improve the nutritional status of the whole body and create conditions for receiving other drug treatments.
Two options for interventional therapy
(1) Compared with systemic intravenous chemotherapy, arterial infusion chemotherapy has the following characteristics:
①. The drug concentration in local tumor tissue is significantly increased, and the circulating drug concentration in the whole body is significantly reduced.
②. The systemic side effects are significantly reduced, while the local organ drug reaction is relatively severe.
③. The dose of chemotherapy drugs used for local infusion can be greatly increased.
④. The curative effect is obviously improved. Arterial infusion chemotherapy is mainly used to insert a catheter into an artery and infuse chemotherapy drugs through the catheter. In recent years, the application of subcutaneous perfusion pump has greatly simplified the operation of arterial perfusion. The main complications of arterial infusion chemotherapy include catheter infection, catheter blockage, catheter shedding, and complications of chemotherapy itself such as liver damage and bone marrow suppression. A colonic stent is placed through the anus to treat colon and rectal strictures.
(2). The treatment of colon and rectal obstruction by placing a metal stent through the anus has achieved good results in relieving symptoms and improving quality of life.
3. Endoscopic treatment of early colon and rectal tumors Due to the continuous development of endoscopy technology and the increasing understanding of early colon and rectal tumors, it is found that the lesions are less than 2 cm, and the infiltration only reaches the mucosal early colon and rectal tumors. Increased, making it possible to treat certain types of early colon and rectal tumors under endoscopy. There are two methods currently used, one is polypectomy for certain raised lesions, and the other is laser treatment , Generally use argon dye and hematoporphyrin. Theoretically speaking, the radical endoscopic treatment of early colon and rectal tumors requires two conditions. One is that the tumor has no lymphatic and distant metastasis, and the other is that the cancer can be completely eliminated. Because the visual observation of the lesion under the endoscope may cause errors, when checking the resection specimens (laser treatment cannot collect specimens), if the lesion is found to be broad-based, or has been soaked to the submucosa, or the resection margin is less than 5 mm from the tumor At that time, a major resection of colon and rectal tumors is required. On the contrary, it is considered to be a radical endoscopic resection, and no further surgery is required.
Four colon and rectal tumor radiotherapy
(1). Preoperative radiotherapy: Refers to preoperative local irradiation for certain advanced colon and rectal tumors that can be felt clinically to increase the resection rate. 200cGY each time, 5 times/week, 4 weeks in total, the total amount is 4000cGY. Surgery was performed on the 14th day after stopping radiotherapy. It can increase the local resection rate, but cannot affect the degree of lymph node metastasis. It takes 6 weeks before surgery. Therefore, the impact on the 5-year survival is difficult to estimate.
(2). Intraoperative radiotherapy.
(3). Postoperative radiotherapy: Most scholars consider it ineffective.
5. Colon and rectal tumor TCM treatment is often used after colon and rectal tumor surgery or combined with chemotherapy and radiotherapy.It has been proved that in the comprehensive treatment of colon and rectal tumors, the use of traditional Chinese medicine and traditional Chinese medicine and other therapies can improve the comprehensive curative effect, especially in reducing the adverse reactions of chemotherapy to the body, improving the body's resistance and improving the quality of life. With the progress in the modernization of Chinese medicine in recent years, the dosage form has changed. There are granules and tablets, which are more convenient to take. There are also injections, which can also be tried for patients with colon and rectal tumors who can no longer take it. In addition, there are many new technologies and methods that integrate Chinese and Western medicine. All of the above can be treated with one or more methods according to the different conditions of patients with advanced colon and rectal tumors. Of course, they can also be treated with their own integrated methods. The principle of Chinese medicine prescription is particularly important in the treatment of advanced colon and rectal tumors, because oral decoction is still the main treatment method. TCM prescriptions for advanced colon and rectal tumors generally include three components.
4. Introduction and comparison of interventional treatment methods
1. Interventional treatment of colon and rectal tumors in various stages
(1). Early colon and rectal tumors. With the continuous development and maturity of endoscopic equipment and technology, as well as a deeper understanding of early colon and rectal tumors, endoscopic treatment of early colon and rectal tumors has matured, and the curative effect reported in the literature can be the same as surgical Surgery is comparable. In addition, there is little damage to the organism, and it has the advantage of repeated treatment for suspected recurrence. At present, there are three methods frequently carried out at home and abroad:
①. Resection directly under the endoscope;
②. Direct injection of chemotherapy drugs and iodized oil (microspheres) under endoscope;
③. Laser treatment under the endoscope. Direct resection under the endoscope is to perform a biopsy of the suspected lesion during gastroscopy, and directly use a larger biopsy forceps to remove the lesion after pathological confirmation. Direct injection of drugs and iodized oil emulsion into the lesion under the endoscope is a further development of intra-arterial chemoembolization to embolize the lesion and lymph nodes.
(2). Interventional therapy that can cure the middle-advanced colon and rectal tumors. The simple radical surgical resection of the middle-advanced colon and rectal tumors is difficult to further improve the long-term survival efficacy of colon and rectal tumors. The combination of surgical resection and interventional therapy has been continuously popular. Acceptance includes the following three aspects:
①. Treatment before radical surgery. Interventional therapy before radical treatment has two aspects:
a. Preoperative treatment that can radically cure colon and rectal tumors;
b. Stage II surgical resection that can not cure colon and rectal tumors after interventional therapy. Preoperative interventional therapy that can radically cure colon and rectal tumors can significantly improve long-term survival. There have been large reports in Japan, Europe and the United States. The main advantages of preoperative treatment that can radically cure colon and rectal tumors are to reduce recurrence and metastasis, and reduce intraoperative bleeding. Stage II surgical resection of lesions shrinking after interventional treatment of colon and rectal tumors that cannot be cured.
②. Treatment after radical surgery. After radical resection of colon and rectal tumors, interventional therapy can reduce or prevent local recurrence and metastasis. At present, the more mature methods include one-shot bolus chemoinfusion at the site of the lesion resection (One-shot bolus chemoinfusion) and continuous long-term intraarterial chemoinfusion (Long-term chemoinfusion). The domestic and foreign literature reports that both methods are better than surgical radical treatment. The short-term and long-term effects of the operation are good.
③. For colon and rectal tumors that have lost the opportunity for surgery, and the treatment of obstruction with internal stents, all use permanent partially covered Nitinol stents, and the stents are placed in the anus under the monitoring of digital subtraction angiography (DSA). Obstruction sites, pre- and post-operative angiographic control were performed, and the curative effect was evaluated according to the eating and defecation conditions, and the clinical follow-up was performed for 3-24 months, with an average of 11 months. Conclusion Part of the coated nickel-titanium alloy stent implantation is malignant in the digestive tract Effective treatment of obstruction. However, malignant obstruction of different parts of the digestive tract should be treated differently, and corresponding materials and operating methods must be used to improve its effectiveness and safety.
Figure 1 Infusion chemotherapy for gastrointestinal tumors
④. Stent placement plus arterial infusion chemotherapy, domestic and foreign literature reports good short-term and long-term effects.
Two advantages of interventional therapy
(1). Regional advantages of interventional therapy Regiopal advantages mainly depend on the pharmacokinetic parameters of different anti-tumor drugs. Data show that drugs with short half-life and high systemic elimination rate have greater regional advantages. If the blood vessels supplying the tumor are blocked at the same time, the regional advantage can be further increased. Therefore, clinically, drugs with short half-life and high systemic clearance are often used, such as 5-FU, DDP, ADM, etc.
(2) The pharmacokinetic advantages of interventional chemotherapy.
(3). Interventional chemotherapy can take advantage of the local anatomical characteristics of tumor tissue. Experimental studies have shown that as the tumor grows, the tumor can develop its own arterial blood supply system. Interventional methods are used for arterial superselection. Carry out perfusion or continuous chemotherapy. In some organ tumors, combined with embolization chemotherapy, the tumor has a high blood concentration, while prolonging the contact time of anti-tumor drugs and tumor cells, increasing the sensitivity of local tumor cells to chemotherapy drugs. Overcome its resistance. Avoid or reduce the systemic toxicity of chemotherapy drugs to achieve the purpose of treating tumors.
(4). The biological effects of interventional chemotherapy have been reported by scholars. Head, neck, limbs and breast tumors. After intraarterial infusion of chemotherapy drugs, local tumors can be seen to have histological changes, and the tumors have resolved significantly within 1 week; electron microscope observations found that 4 Day, the tumor cells appeared vacuoles, the tumor cells swelled and the organelles were completely dissolved within 1 week. It proves that tumor cells have irreversible damage, indicating that interventional chemotherapy can produce obvious biological effects on local tumor tissues.
Three chemotherapy regimens FCM (5-FU+CDDP+MMC) or FAM (5-FU+ADM+MMC). The dose of chemotherapy drugs is 5-FU 750～1250mg, CDDP 80～120mg, MMC 10～20mg, ADM 40～120mg.
Four embolization material selection According to the angiography, the approximate diameter of the tumor is measured. The amount of lipiodol (ml) is determined in the range of 1 to 1.5 times the diameter of the tumor (cm). The lipiodol is 38% French super-liquefied lipiodol. The immunization preparation chooses domestically made sapylin, the specification of each bottle is 5KE, and the amount of treatment per patient is 20KE. Before internal embolization, add Sapylin 20KE directly to an appropriate amount of super-liquefied lipiodol, and suck back and forth to fully emulsify. The external embolization uses self-made gelatin sponge particles.
5 Contraindications and indications of interventional therapy
(1). It is suitable for bowel stenosis or obstruction caused by malignant tumor invasion and compression, resulting in poor defecation or defecation disorder, colon and rectal fistula.
(2). Patients with colon and rectal tumors who cannot or refuse surgical resection.
(3). Treatment before and after radical resection or palliative resection of colon and rectal tumors.
(4). Cancerous ulcers with hemorrhage.
(5). It is suitable for anastomotic stenosis of the colon and rectum after surgery. Stent placement can also be used as an emergency treatment during the transition period before surgery.
(6) Patients with gastrointestinal tumors with distant metastases can be treated with local intra-arterial chemotherapy to increase the comprehensive therapeutic effect.
(1) Those with abnormal blood coagulation function.
(2). Patients with insufficiency of heart, lung, liver and kidney function.
(3). Severe systemic failure and cachexia.
(4). Severe internal hemorrhoids or perianal varicose bleeding period.
(5.) Acute inflammation, bleeding period of ulcerative colitis.
(6). Suspected extensive small intestine obstruction.
(7). Patients who cannot cooperate.
(8). Those allergic to iodine.
6 Preoperative preparation
A patient prepares the patient for all necessary examinations before the operation. Generally speaking, there are no absolute contraindications for interventional radiology examinations. However, attention must be paid to bleeding and clotting time. For abnormal patients, prothrombin time must be measured. For anticoagulant therapy, anticoagulant drugs should be stopped if possible, and dehydrated patients should be fully hydrated. Patients with hypertension should be controlled with drugs. And make the following preparations: 1 iodine allergy test; 2 heart, lung, liver and kidney function tests, and correction for insufficiency; 3 coagulation time and routine blood tests, and correction for poor ones; for hypoalbuminemia, intermittent infusion of plasma or albumin Etc.; 4 preventive use of antibiotics, 1 / 2h before surgery and every 3h during the operation to give 1 dose, and then give 2 to 3 doses after surgery. Antibiotics should be broad-spectrum drugs, such as aminoglycosides, cephalosporins, and anti-anaerobic drugs, such as metronidazole; 5 Fasting for 4 hours before surgery; 6 Skin preparation at the puncture site, and shave local pubic hair or axillary hair And clean it; 7 30 minutes before surgery, subcutaneous injection of luminal sodium 0.1㎎ and atropine 0.5㎎. Portal hypertension is mostly caused by liver cirrhosis. The quality of liver function compensation is directly related to the success or failure of the operation. Therefore, sufficient preoperative preparation must be made to reduce the occurrence of postoperative complications and ensure the success of the treatment.
2. Equipment and medicine preparation:
(1). Contrast catheters, guide wires, puncture needles, catheter sheaths, permanent partial coated Nitinol stents, sp microcatheters should be prepared in addition to the preparation of conventional equipment;
(2) Intraoperative medication:
①. Local anesthetics: 0.1% procaine or lidocaine is commonly used
②. Anticoagulant: commonly used heparin sodium;
③. Contrast agent: ionic or non-ionic contrast agent;
④. Analgesic and tranquilizers such as Dulanding injection, etc.;
⑤. PVA particles, gelatin sponge;
Three surgeon preparation Although interventional therapy is relatively safe and reliable, it is traumatic after all. Before the operation, the surgeon should understand the patient's medical history, perform the necessary physical examination, and conduct a comprehensive analysis of various related laboratory tests or other examinations to make a preliminary clinical diagnosis. Talk to the patient in person, explain the interventional radiology examination or treatment method, value, and possible complications in a realistic manner. After obtaining the patient’s consent, you must consider specific measures. The equipment used should be prepared one by one, and the operation steps and imaging Preliminary plans are made for dosage, contrast location and filming procedures. Those undergoing angiography should wear masks, hats, wash hands, wear sterile gloves, and wear sterile gowns.
7 Operation technique and intraoperative precautions
1. Arterial infusion chemotherapy The Seldinger technique is routinely used for interventional therapy. The puncture site can choose femoral artery, brachial artery, axillary artery, pelvic artery, etc., depending on the location of the disease. Because the femoral artery is relatively superficial, it is convenient to puncture and cannulate, the success rate is high, the operation is safe and reliable, and there are few complications. At present, the femoral artery is the most commonly used puncture site. The specific method is: first disinfect the skin at the puncture site, and perform local anesthesia. At the upper edge of the femoral artery pulsation, use a 2mm skin incision, and the arterial puncture needle will enter the femoral artery at an angle of 30 to 40 degrees. If the puncture needle pulsates along the longitudinal axis of the femoral artery, the puncture is successful. At this time, after the needle core is removed, the arterial blood ejected from the needle tail should be seen. The guide wire should be immediately sent into the femoral artery through the puncture cannula. After exiting the cannula, fix the guide wire, and then send the arterial catheter along the wire into the blood vessel Inside, finally exit the guide wire. All operation processes should be carried out under open line monitoring. After the arterial catheter enters the target vessel area, angiography should be performed first to understand the source and distribution of the local tumor blood vessels, so as to use it for further super-selective treatment to make the arterial catheter closer to the tumor site.
Two internal stents are placed in the treatment of obstruction, all using permanent partially coated nickel-titanium alloy stents, and the stents are placed in the obstructed area through the anus under the monitoring of digital subtraction angiography (DSA), preoperatively Afterwards, they were compared with the contrast, the curative effect was evaluated according to the eating and defecation situation, and the clinical follow-up was 3-24 months.
Figure 1 Arterial infusion chemotherapy for colon cancer
Figure 2 Stent placement for rectal cancer
8 Postoperative treatment
(1). The patient is absolutely bed rest for 24 hours, the puncture side limb is stretched for 24 hours, and the puncture site is pressed by the sandbag for 6 hours to prevent the blood clot from falling off at the puncture site, causing subcutaneous hematoma or hemorrhage. You can get up and move later to observe whether there is bleeding, Blood oozing and pay attention to the skin color, temperature, and sensation of the distal limb. If there is no gastrointestinal reaction, you can eat early, especially hydrating, to help excrete the contrast agent to prevent renal damage. Due to improper compression after extubation, hemorrhage or hematoma at the puncture site may be caused. Especially obese patients are more difficult to oppress, therefore, the operator must master it well. Do not move your fingers during compression, and do not allow the patient to move. If everything is done routinely and the puncture site still does not stop bleeding, attention should be paid to whether the patient's blood clotting mechanism is normal or whether the amount of heparin is too large. Excessive heparin can be offset by protamine; and patients with blood clotting mechanism disorders should use hemostatic drugs. Tell the patient that postoperative body temperature can increase in different degrees, up to 38 ℃, usually lasting for about 2 to 3 weeks, caused by necrosis, to relieve their anxiety. Record the patient's 24-hour urine output to observe changes in renal function.
(2). Instruct patients to eat semi-liquid or soft food, mainly carbohydrate food, supplemented by high vitamin foods such as fruits and vegetables. Fasting raw, cold, hard and other irritating foods.
(3). Closely observe whether there are complications.
(4). Postoperative imaging is done to understand the position of the stent. If symptoms are found, report to the doctor in time, and deal with them symptomatically.
9 Complications and prevention
1. Common complications after arterial chemoembolization include abdominal discomfort, nausea, vomiting, hematemesis, black stool and fever, etc. This is called post-embolization syndrome and usually lasts about 1 week. Serious complications include ischemic infarction, necrosis, ulcers, bleeding, and perforation, but they are not common.
2. Complications of stent placement are mainly discomfort and sense of bowel movement. There are very few colon injury bleeding, perforation and internal bleeding, which can be dealt with accordingly. Due to the contraction and peristalsis of the intestine, the stent may fall off and shift after the operation, and it will be discharged by itself, which generally does not cause other complications. In the later stage, restenosis or obstruction occurs due to continuous tumor growth and insufficient support of the stent. If it occurs, the stent can be inserted through the original stent.
3. In addition to conventional hydration treatment and symptomatic treatment (including analgesia, antiemetics, gastric mucosa protection, etc.), the main symptom is the fever caused by immune preparations, such as taking cooling measures when fever is above 38.5℃. And given drugs to cool down. After arterial intubation chemoembolization, almost all patients can have symptoms of varying degrees, including nausea, vomiting, pain and fever at the local embolization site. After symptomatic treatment, it usually disappears within 2 weeks. Improper operation can cause vascular damage in individual cases, such as vasospasm, intimal damage, and hematoma formation at the puncture site. Appropriate application of vasospasmodics and vasopressor at the puncture site can restore vascular injury. It should be noted that the embolic material reflux causes misthrombosis of non-target organs, and clinical peptic ulcers or abscesses may occur. According to the operation of different parts of the blood vessel, different organs are mistakenly inserted, and there are various clinical manifestations. In order to avoid accidental embolization of non-target organs, the level of operation technology should be improved. Under the monitoring of thread adjustment, insert the arterial catheter to an appropriate depth, as close as possible to the target vessel area of the tumor. When injecting embolic agents, the pressure should not be too high; postoperative anti-inflammatory and infusion therapy should be strengthened, and anticoagulants should be used appropriately. In most cases, accidental injury to the operated blood vessel can be avoided.
10 Efficacy evaluation and treatment interval
1. Permanent partial covered nickel-titanium alloy stent placement is an effective treatment method for the relief of malignant obstruction of the digestive tract. It is easy to operate and has high safety.
2. Stent placement plus arterial infusion chemotherapy has good short-term and long-term effects.
3. Intra-arterial chemotherapeutic drug perfusion for colon and rectal tumors via catheter is better than traditional oral or intravenous infusion of chemotherapeutic drugs. It is simple and easy to implement. Generally, the drug concentration in the blood circulation reaches its peak within a few minutes to 30 minutes. Pharmacokinetic studies show:
(1). The killing effect on cancer cells is concentration-dependent within a certain range, that is, if the local concentration is increased by 1 time, the number of tumor cells killed can be increased by about 10 times.
(2). Some anti-cancer drugs such as MMC, CDDP, 5-FU, etc. are mainly cleared by the liver, and the efficacy of extrahepatic organ arterial perfusion can be improved.
(3). Local catheter chemotherapy reduces the amount of drug exposure to non-target organs, and the systemic toxicity is small.
(4). Regional infusion chemotherapy for certain organs can treat metastases outside the target organs and have similar effects to intravenous chemotherapy. More chemotherapeutic doses or several anticancer drugs with different mechanisms can be injected into the arteries at a time Combined with high-dose perfusion into the artery of the tumor area, the local drug concentration is high, which enhances the ability to directly kill tumor cells and inhibit their growth, reduces the systemic drug concentration and toxic side effects, and enhances the patient's tolerance to chemotherapy. The drug flows back to the tumor through the tumor vein. The portal vein can directly kill cancer cells in the blood, reduce the chance of blood metastasis after surgery, prevent the metastasis of other organs, improve clinical symptoms, improve quality of life, shrink tumors, and facilitate surgical resection.
Four time intervals have data indicating that: after 3 chemoembolization, the patient’s immunity and resistance is the lowest period. Therefore, the first or less than 3 treatments are recommended, and the development of the lesion should be controlled as much as possible, that is, peripheral embolism. The amount should be as equal as possible to the size and volume of the lesion, and supplemented by central embolism to reduce the scouring effect of blood flow on iodized oil. Therefore, the number of treatments should be 3 to 5 times, and the interval between 3 times should be 2 to 3 months; more than 3 times can be determined according to the changes in the digestive tract barium meal or CT follow-up lesions.
11 Follow-up and follow-up
The imaging monitoring of tumor response after colorectal tumor intervention has two purposes:
(1). Monitoring the response to treatment at the primary site.
(2). Whether there is metastasis in other parts. The two are closely related and directly related to the efficacy and further treatment options. The monitoring after treatment of the primary tumor includes changes in the size of the lesion and the internal structure of the lesion. The methods include gastrointestinal barium meal, colonoscopy, CT and MR, as well as routine photography and radionuclide. More commonly used are colonoscopy, gastrointestinal barium meal and CT. Some scholars believe that the combination of gastrointestinal barium meal and colonoscopy is the first choice, which is performed once within 1 to 2 months to monitor changes in the size of the lesion; while B-ultrasound and radionuclide examination are used as a means to understand whether the patient has metastasis to other parts.
12 Preoperative talk and signature, matters needing attention
13 Surgical records
14 Experience and Lessons
Normal anatomical vessels should use conventional angiography catheters, and the superior mesenteric artery guide wire should not be inserted too deeply to avoid arterial spasm. Try to avoid using guide wires for the inferior mesenteric artery to avoid spasm.
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24 Wang Xiaolin, Li Maoquan, Chen Ying. COX survival model analysis of gastric arterial chemotherapy perfusion and embolization. Journal of Shanghai Medical University, 1993; 20(6): 424-427
25 Gu Qinlong, Wang Tianxiang, Yin Haoran, et al. A preliminary study on the treatment of gastrointestinal tumors with tumor infiltrating lymphocytes. Chinese Journal of Practical Surgery, 1995; 15(2): 730-73
26 Su Xiuqin, Meng Xiangwen, Zhang Jin, et al. Experimental study on mitomycin gelatin microsphere embolization of left gastric artery. Journal of Interventional Radiology, 2001, 3(10): 171-174
27 Li Maoquan. Current status and research progress of interventional therapy for gastric cancer. Journal of Interventional Radiology, 1999, 8: 51-53.