胃癌根治术后动脉区域灌注化疗与全身静脉化疗的临床疗效比较

Comparative study on clinical effect of postoperative arterial infusion chemotherapy and systemic chemotherapy in gastric cancer

目的研究胃癌根治术后进行的动脉区域灌注化疗是否优于全身静脉化疗。方法从1997年7月至2002年7月,将行根治性切除术后的进展期胃癌患者随机分为两组,在术后3周开始化疗。全身静脉化疗组：188例,第1天氟尿嘧啶(5-FU)750 mg、吡柔比星(THP)50 mg和丝裂霉素(MMC)8 mg；第2天5-FU 500 mg；第8天5-FU 1000 mg；第29天5-FU 750 mg、THP 50 mg和MMC 8 mg；第30天5-FU 500 mg；第36天5-FU 1000 mg；均经外周静脉滴注完成1个疗程；间隔2周再进行1个疗程；共用2个疗程。动脉区域灌注化疗组：180例,按Seldinger法穿刺股动脉,在DSA电视荧屏监视下。将导管经股动脉、髂动脉、腹主动脉插入腹腔动脉,经导管注入5-FU 1000 mg、THP 50 mg和MMC 8 mg；每4周进行1次共4次。结果两组患者性别、年龄、肿瘤位置和组织学类型及TNM分期、手术类型的差异均元统计学意义(P＞0．05)。动脉区域灌注化疗组术后1、3、5年生存率分别为93．3%、72．2%和53．6%；而全身静脉化疗组则分别为87．2%、53．7%和43．1%；两组比较P＜0．01,差异有统计学意义。结论胃癌患者在根治术后进行动脉区域灌注化疗其生存率高于全身静脉化疗。

Objective To compare the clinical effect of postoperative arterial infusion chemotherapy and systemic chemotherapy in gastric cancer. Methods From July 1997 to July 2002, the patients undergoing radical gastric resection were randomly divided into two groups, and received systemic or arterial infusion chemotherapy three weeks after radical resection. Systemic chemotherapy was carried out for two courses with 5-fluorouracil（S-FU）, pirarubicin （THP）, and mytomycin （MMC） administered according to FAM program, while arterial infusion chemotherapy for four courses with the same anticancer drugs infused via the celiac artery. The outcomes were compared. Results Systemic chemotherapy was carried out in 188 cases, and arterial infusion chemotherapy in 180 cases. There were no significant differences in sex, age, tumor location, histological type, TNM stage and surgical procedure between the two groups（ P 〉 0. 05）. The 1,3, 5 year survival rates were 87. 2%, 53.7% and 43. 1% in systemic chemotherapy, and 93. 3%, 72. 2% and 53.6% in arterial infusion chemotherapy respectively （ P 〈 0. 01 ）. Conclusion The survival rate of the patients with arterial infusion chemotherapy is higher than that with systemic chemotherapy, which indicates that arterial infusion chemotherapy can remarkably improve the prognosis of the patients with gastric cancer.