【作者】 席林青； 张晓东； 沈琳； 李建； 李洁； 金懋林；

【Author】 Xi Lin-Qing Zhang Xiao-Dong Shen Lin Li Jian Li Jie Jin Mao-Lin

【机构】 北京市肿瘤医院消化内科；

【摘要】 目的:观察胃癌根治术后早期经皮腹腔置管腔内化疗对术后腹腔局部复发、无病生存、总生存、局部并发症及毒副反应的影响。方法:采用前瞻性、单中心对照研究。40例胃腺癌根治术后病理诊断明确的Ⅲ-Ⅳ期患者,分为研究组 (腹腔化疗+全身化疗)和对照组(仅行全身化疗),每组20 人。研究组在术后1月内先行经皮腹腔保留置管(Arrow公司 14号导管),腹腔内顺铂、氟脲苷灌注,每周1次,行2—3次。随后行全身化疗,方案为草酸铂、氟脲嘧啶、甲酰四氢叶酸等,对照组在术后仅行全身化疗,方案同研究组。结果:研究组1年无病生存率为60％,较对照组(25％)增高,P<0．05, 两组差别有统计学意义。中位无病时间(月),总生存时间 (月)、腹盆腔复发转移出现时间(月)较对照组延长,分别为 13:6．5,18:13．5,15:10．5,但P>0．05, 1年总生存率为85％,较对照组(70％)略增高(P>0．05),两组差别无统计学意义。两组均无明显肝肾功能损害,但有轻度消化道反应。所有病人均有程度不等的白细胞下降。研究组未出现与腹腔灌注治疗相关的出血、感染、化疗药外漏、导管阻塞、导管脱落、胃肠穿孔、发热等并发症。结论:胃癌术后早期经皮腹腔置管腔内灌注化疗对提高胃癌根治术后1年无病生存率有一定疗效。此种方法并发症少,耐受性好,具有一定的实用性及可行性,但需进一步扩大临床验证。更多还原

【Abstract】 Objective: The aim of this study was to evaluate the toxicity, feasibility, and efficacy of early postoperative adjuvant intraperitoneai chemotherapy (IPCT) for gastric cancer to prevent intraperitoneai recurrence and prolong disease-free survival (DFS ) and overall survival. Mothods: The study was a prospective controlled clinical trial. Between December 2001 and December 2005 at our institution, forty patients were enrolled. Patients with stage III - IV gastric cancer aged between 18 and 75 years, after curative resection, with adequate liver, renal, and cardiac function were included in the study. Twenty patients underwent adjuvant chemotherapy plus intraperitoneal chemotherapy (IPCT group) and the remaining 20 patients underwent adjuvant chemotherapy alone (control group). The intraperitoneal chemotherapy regimen consisted of cisplatin 80mg and 5-FU 1000 mg with 2000ml normal saline delivered intraperitoneally. Intraperitoneal fluid was not drained. Each course of IPCT was repeated every 1 week for total 2-3 cycles. The chemotherapy regimen consisted of oxaliplatin 、5-FU and folinic acid every 2 weeks for total 8 cycles. Results : The 1 year DSF for the IPCT group was 60%, and for the control group was 25%, The IPCT group had a significant survival benefit compared to the control group (P <0.05). The 1-year overall survival rate was higher in the IHCP group than that in the control group, 85% vs. 70%, P >0.05. The treatment was generally well tolerated in the two groups. The most common toxicity was neutropenia and nausea. The grade 3 neutro-penia was 10 %(2/20) in IPCT group. No treatment-related death was reported. Conclusion: Early postoperative adjuvant intraperitoneal chemotherapy in patients with advanced gastric cancer has less side effect and good toleration. The combine of intravenous and intraperitoneal chemotherapy after gastrectomy may have better treatment effect on gastric cancer than that of intravenous chemotherapy alone.更多还原