胃癌患者术中腹腔低渗热灌注化疗的长期预后观察

Influence of hypotonic intraoperative intraperitoneal chemohyperthermia (HIPCH) on the long term survival of patients with gastric cancer

目的观察术中腹腔低渗热灌注化疗对胃癌患者术后长期生存的影响。方法将施行胃癌根治术的105例患者随机分为低渗热化疗组(31例,术中予以腹腔低渗热灌注化疗)、等渗热化疗组(37例,术中等渗热灌注化疗)和对照组(37例,术中腹腔不作任何灌注治疗),观察比较3组患者的手术并发症发生率和术后长期生存率。结果手术并发症发生率3组患者间的差异无显著性意义(P>0.05)。5年生存率低渗热化疗组(67.7%)和等渗热化疗组(64.9%)显著高于对照组(46.0%),分别与对照组比较,P=0.0123和P=0.0476;但两个热化疗组间比较,差异无显著性意义(P=0.434)。低渗热化疗组10例复发,复发时间(23.6±9.1)个月;等渗热化疗组13例复发,复发时间(14.6±8.1)个月;对照组20例复发,复发时间(10.1±5.2)个月;低渗热化疗组肿瘤复发时间显著晚于对照组和等渗热化疗组(分别为P=0.0001和P=0.0206),而等渗热化疗组与对照组比较,差异无显著性意义(P=0.0603)。结论低渗热化疗与等渗热化疗均能提高患者的生存率,低渗热化疗在延缓肿瘤复发上优于等渗热化疗。

Objective To investigate the influence of hypotonic intraoperative intraperitoneal chemohyperthermia (HIPCH) on the long term survival of patients with gastric cancer. Methods One hundred and five patients were randomly divided into 3 groups. HIPCH group(n=31) received heated intraperitoneal cisplatin in hypotonic solution immediately after radical gastrectomy, chemohyperthermia group(n=37) received intraoperative intraperitoneal chemohyperthermia (IPCH), and the control group(n=37) underwent curative surgery without any perfusion therapy. Operative complications were investigated, and Kaplan-Meier method was used to estimate the survival rate of the three groups. Results No difference was found in the morbidity rate among the three groups(P >0.05). The survival rates of HIPCH group and chemohyperthermia group were higher than that of the control group(P=0.0123 and P=0.0476, respectively), but no difference was found between the former two groups (P=0.434). The interval before tumor recurrence was significantly longer in HIPCH group than those in chemohyperthermia group and the control group (P=0.0206 and P=0.0001, respectively). Conclusion Both HIPCH and IPCH are considered to improve the survival rate of the patients with gastric cancer, and HIPCH demonstrates an efficacy in postponing tumor recurrence.