腹腔序贯灌注化疗治疗晚期胃癌的临床观察

Clinical Observation of Sequential Chemotherapy via Abdominal Cavity Instillation in Advanced Gastric Cancer

[目的]观察晚期胃癌采用腹腔序贯灌注化疗的疗效及不良反应.[方法]32例晚期胃癌患者腹腔留置中心静脉导管,d1腹腔内注入氟尿嘧啶(5-Fu)1.5 g、丝裂霉素(MMC)10 mg、顺铂(DDP)80 mg;d1 5腹腔内注入硝卡芥(AT-1258)80 mg、羟基喜树碱(OPT)40 mg,均加以地塞米松10 mg及生理盐水2000 ml腹腔保留灌注.每30天重复为1周期,每例患者至少完成2～3周期后评价疗效.[结果]总有效率为62.50%(20/32),其中控制腹水有效率为81.25%(13/16),治疗转移灶有效率为56.25%(18/32),初、复治患者疗效比较无统计学意义(P＞0.05).KPS评分治疗后升高者占78.13%(25/32).1年生存率为59.38%(19/32),2年生存率为12.50%(4/32),中位生存期(11±3.87)个月.主要不良反应是轻度的血液毒性及消化道反应,患者可耐受.[结论]腹腔留置中心静脉导管安全,方法简便易行.腹腔序贯灌注化疗治疗晚期胃癌疗效确切,不良反应轻微,值得临床进一步观察.

[Objective]To observe the efficacy and toxicity of sequential chemotherapy via abdominal cavity instillation in advanced gastric cancer. [Methods]Thirty-two cases were treated with abdominal cavity puncture via central venous catheter followed by intraperitoneal administration of fluorouracil（5-Fu） 1.5 g, mitomycin （MMC） 10mg, cisplatin（DDP） 80mg in d1 and nitrocaphane 80mg, hydroxycamptothecin（OPT） 40mg in d15. The chemotherapy was performed by means of abdominal cavity retention instillation with dexamethasone 10mg and saline 2000ml. Above-mentioned medications were repeated every 30 days. For need of evaluation, all patients should complete at least two or three cycles. [Results]The total effective rate was 62.50% （20/32） including that the ascites control and metastasis therapy response rates were 81.25% （13/16）and 56.25 % （18/ 32）respectively. No statistical significance between initial and retreatment group was found（ P〉0.05）. The KPS score improved rate was 78.13%（25/32）. One and two year survival rates were 59.38%（19/32）and 12. 50% （4/32）respectivly. The median survival time was （11±3.87） months. The main adverse reactions were minor blood toxicity and digestive tract response which patients could endure. [Conclusion]The method of abdominal cavity puncture with central venous catheter is a safe and convenient way. The sequential chemotherapy via abdominal cavity instillation is an efficient and low-toxicity treatment in advanced gastric cancer. More random and control clinical observation should he taken.