热灌注加强治疗对胃癌手术后复发的影响

Effect of hyperthermic intraoperative intraperitoneal chemotherapy on the prevention of gastric cancer recurrence after operation

目的:探讨术中热灌注加强治疗对进展期胃癌术后复发的影响。方法:回顾分析2002年10月～2005年9月收治的进展期胃癌按照手术时间顺序分为术中腹腔内温热灌注化疗(hyperthermic intraoperative intraperitoneal chemotherapy,HⅡC)即实验组,单一手术治疗即对照组。实验组在手术中辅以HⅡC加强治疗,即将替加氟注射液600～1000mg加入42～44℃的蒸馏水2000ml中,于关腹前留置腹腔内15～20min。两组均在术后8～15天,肝、肾功能正常、外周血WBC正常后开始接受常规静脉化疗,并比较两组术后6、12、18、24个月的复发情况。结果:两组术后6、12个月复发转移差异无显著性,18、24个月的复发转移情况,实验组分别为13例占18.3%,15例占21.1%;对照组分别为28例占35%,33例占41.3%,两组差异有显著性P<0.05。结论:进展期胃癌术中行HⅡC加强治疗可以降低术后复发。

Objective ：To explore the effect of hyperthermic intraoperative intraperitoneal chemotherapy on the prevention of gastric cancer recurrence after operation.Methods：From October 2002 to September 2005,151 patients with advanced gastric cancer were randomly divided into two groups ：the treatment group received operation combined with intraperitoneal hyperthermic perfusion chemotherapy （HIIC）,i.e. preceding abdominal closure patients received HIIC （tegafur 600-1000 mg was added into 2000 ml distilled water,heated to 42-44 ℃ ,perfused to abdominal cavity for 15-20 minutes and then sucked）;While the control group received conventional operation only.Both groups were begun with intravenous chemotherapy after getting normal hepatic function, renal function and white blood cell count,i.e. 8-15 days after operation. The recurrence rates of patients in 6-, 12-, 18- and 24-month after treatment were compared between the two groups.Results：The 6- and 12-month recurrence rates after operation were not significantly different between the two groups. However, the 18-and 24-month recurrence rates in HIIC group were 18.3%（13 patients）/21.1%（15 patients） and in control group 35%（28 patients）/41.3%（33 patients） respectively. The 18-and 24-month recurrence rates were significantly different between the two groups （P〈 0.05）.Conclusion：Operation combined with HIIC can reduce long-term recurrence rate after operation in patients with advanced gastric cancer.