伴有血性或非血性腹水肝癌患者的腹腔化疗研究

Study on the efficacy and safety of intraperitoneal chemotherapy in treatment of hepatoma patients with non-bloody or bloody ascites

目的观察腹腔化疗对伴有血性或非血性腹水肝癌患者的疗效及安全性是否相同。方法将伴有腹水的43例肝癌患者按腹水性质及治疗方法分为4组：A组13例，为非血性腹水进行腹腔化疗组；B组15例，为非血性腹水对症治疗组；C组8例，为血性腹水进行腹腔化疗组；D组7例，为血性腹水对症治疗组。腹腔化疗均采用羟基喜树碱（HCPT）16mg／m^2、氟尿嘧啶（5-Fu）1000mg／m^2、地塞米松10mg，1周后重复，共2～4次。结果A组中位生存时间（MST）为4．3个月（1．8～9．3个月），腹水完全缓解（CR）1例（7．7％），部分缓解（PR）5例（38．5％），有效率46．2％，治疗期间常见副反应为白细胞、血小板下降；B组MST为2．5个月（1．7—8．3个月），腹水控制有效率0；C组MST为1．3个月（0．5—1．4个月），腹水控制有效率0，治疗期间常见副反应为恶心、呕吐以及白细胞、血小板下降；D组MST为1．8个月（0．8—2．9个月），腹水控制有效率0。结论腹腔化疗对非血性腹水的肝癌患者有一定疗效，但对血性腹水的肝癌患者疗效不佳。

Objective To observe whether the efficacy and safety of intraperitoneal chemotherapy in hepatoma patients with non-bloody ascites is same as those in patients with bloody ascites. Methods Fortythree hepatoma patients were divided into 4 groups according to the character of ascites and the therapy method. Group A included 13 patients with non-bloody aseites treated with intraperitoneal chemotherapy. Group B included 15 patients with non-bloody ascites treated with palliative therapy. Group C included 8 patients with bloody ascites treated with intraperitoneal chemotherapy. Group D included 7 patients with bloody ascites treated with palliative therapy. The intraperitoneal chemotherapy method was hydroxycamptothecin （HCFF） 16mg/m^2, 5-fluorouracil （5-Fu） 1000mg/m^2, dexamethasone 10mg, repeated every 1 week, 2-4 times altogether. Results The median survival time （MST） of group A was 4. 3 months （ 1.8-9. 3 months ）. One case got CR of ascites （7. 7% ） and 5 cases PR （38.5%）. The effective rate was 46. 2%. The main side effects included neutropenia and thrombocytopenia. The MST of group B was 2. 5 months （ 1.7- 8. 3 months ）. The effective rate（control of ascites） was 0. The MST of group C was 1.3 months （0. 5-1.4 months ）. The effective rate was 0. The main side effects included nausea, vomiting, neutropenia and thrombocytopenia. The MST of group D was 1.8 months （0. 8-2. 9 months ）. The effective rate was 0. Conclusion The intraperitoneal chemotherapy is effective tor treatment of hepatoma patients with non-bloody ascites, but is noneffective for treatment of hepatoma patients with bloody ascites.