【摘要】 目的:探讨术前动脉灌注化疗对进展期胃癌的临床疗效。方法:选择Ⅲ、Ⅳ期的进展期胃癌患者60例,随机分为:试验组31例行术前动脉灌注化疗,方案为奥沙利铂(艾恒)150mg/m2、羟基喜树碱20mg/m2、氟脲苷750mg/m2、亚叶酸钙200mg/m2,经股动脉插管灌注化疗1次,12～14天后接受手术治疗;对照组29例直接手术治疗。观察动脉灌注化疗不良反应及组织学疗效,比较两组手术切除率、手术并发症、术后病理分期及远期生存率。结果:试验组动脉灌注化疗不良反应主要表现为胃肠道反应和骨髓抑制,均属Ⅰ～Ⅱ度。试验组手术切除率为100%(31/31)、R。切除率为90.3%(28/31),分别高于对照组的72.4%(21/29)和51.7%(15/29),P均<0.05;试验组组织学有效率达83.9%,病理分期均较术前降低,其中Ⅱ期病例明显较对照组增多(P<0.05)。试验组中位生存期为29.0个月,1、3、5年生存率分别为90.3%、41.9%、16.1%;对照组的中位生存期为17.0个月,1、3、5年生存率分别为79.3%、13.8%、10.3%,试验组生存率高于对照组,但仅3年生存率具有统计学意义(P<0.05)。术后并发症两组之间差异无统计学意义(P>0.05)。结论:术前动脉灌注化疗对进展期胃癌降低临床分期,提高手术切除率尤其是根治性切除率作用疗效确切,并对提高患者的中期生存率具有重要意义。更多还原

【Abstract】 Objective: To evaluate the curative effect of preoperative arterial infusion chemotherapy on ad- vanced gastric cancer. Methods: A total of 60 cases of advanced gastric cancer (stage Ⅲ or Ⅳ) were random- ly divided into 2 groups. The test group (31 cases) received preoperative arterial infusion chemotherapy with a regimen of Oxaliplatin (L-OHP) 150mg/m2, Hydroxycamptothecin (HCPT) 20mg/m2, Dexifluridine (FUDR) 750mg/m2 and Leucovorin 200mg/m2. Infusion chemotherapy was administrated through the femoral artery at 12-14 days before surgery. The control group (29 cases) received surgery alone. The adverse reactions and histological effects of arterial infusion chemotherapy were observed. The resection rate, complications, pathol- ogy stage and long term survival were compared between the two groups. Results: Adverse effects of arterial infusion chemotherapy were mostly grade Ⅰ - Ⅱ gastrointestinal discomfort and bone marrow depression. The resection rate was 100% (31/31) in the test group, and 28 cases (90.3%) underwent curative (RO) resection, a higher percentage than that found in the control group [72.4% (21/29) and 51.7%]. Histological effects in the test group were also higher than those in the control group. The median survival time of the test group was 29.0 months. The 1-, 3-, and 5-year survival rates were 90.3%, 41.9% and 16.1%, respectively, in the test group. In the control group, the resection rate was 72.4% (21/29) and 15 cases (51.7%) had R0 resection. The median survival time was 17.0 months. The 1-, 3-, and 5-year survival rates were 79.3%, 13.8% and 10.3%, respectively. A significant difference was found in the 3-year survival rate between the two groups. Conclusion: Preoperative chemotherapy via arterial infusion is of great significance in downstaging the pathol- ogy of advanced gastric cancer and for improving the excision rate (especially radical resection) and the sur- vival rate.更多还原