【摘要】 背景与目的:目前我国胃癌早期发现率较低,80%的胃癌患者就诊时即为进展期,总体疗效较差。本研究采用对照研究,旨在探讨术前动脉介入化疗(preoperative arterial infusion chemotherapy,PAIC)治疗进展期胃癌的价值及其安全性。方法:治疗组:诊断明确,自愿接受PAIC,无强烈全身反指征者列入治疗组。105例临床诊断为Ⅱ期以上胃癌患者在术前接受动脉介入化疗,方案为:氟尿嘧啶(5-FU)750mg/m2,丝裂霉素(MMC)10mg/m2,顺铂(DDP)60mg/m2。经股动脉插管至相应病灶供血区一次性灌注化疗,7～10d后行胃癌根治术手术。对照组:不愿接受或全身情况不允许行动脉化疗者列入对照组。同期收治95例Ⅱ期以上进展期胃癌患者行常规手术+术后静脉化疗。观察动脉介入化疗后肿瘤病灶的病理变化、不良反应及生存率变化。结果:动脉介入化疗组105例全部完成术前介入化疗,不良反应主要是胃肠道反应、骨髓抑制、个别病例(2例)动脉介入化疗后2～3d发生胃出血。化疗后全部施行切除性手术,其中91例(86.6%)获得根治性切除R0,术后并发症发生率为18.1%。1、3和5年生存率分别是96.2%、68.6%和52.4%。常规手术组65例(68.6%)获得R0切除,术后并发症发生率是22.1%。1、3和5年生存率分别是88.4%、38.9%和28.4%。结论:术前动脉介入化疗能提高进展期胃癌患者的手术切除率和术后生存期;机体对介入化疗的耐受性良好,全组无严重不良反应。术前介入化疗对改善胃癌患者预后具有重要价值。更多还原

【Abstract】 Background and purpose:In China, incidence of gastric cancer is high but early diagnosis is low and treatment results remains poor.The role of neoadjuvant chemotherapy for patients has been explored.In this study, we evaluated the effects and safety of preoperative intra-arterial infusion chemotherapy(PAIC) for advanced gastric cancer.Methods:One hundred and five patients with clinic stage-Ⅱ above advanced gastric cancer were submitted to preoperative intra-arterial infusion chemotherapy using the Seldinger technique.The regimen consisted of 5-FU 750 mg/m2, MMC 10 mg/m2, and DDP 60 mg/m2.Seven to ten days after the PAIC, all 105 patients received operation.Other 95 patients underwent surgery directly as control group.The responses by the tumor lesion and chemotherapy toxicity were observed.The long term survival rate were also evaluated.Results:Pathological examination showed that the tumor cells had changed by chemothrapy.Common adverse effects of PAIC were grade Ⅰ-Ⅱ gastrointestinal discomfort and bone marrow depression.No gastric rupture had occurred.Ninety-one cases(86.6%) underwent curative resection.The 1, 3, and 5-year survival rate was 96.2%, 68.6%, and 52.4% respectively.Among 95 patients with control group, sixty-five cases(68.6%) underwent curative resection.1,3,and 5-year survival rates were 88.4%,38.9% and 28.4%,respectively.Conclusion:PAIC is an effective, and safety chemotherapeutic treatment for advanced gastric cancer.It can affer treatment downstage of disease and enhances resectability.It may also improve the prognosis of advanced gastric cancer.更多还原