两种方案治疗胃癌晚期病人恶性腹水的临床研究

THE CLINICAL STUDY OF TREATING MALIGNANT ASCITES IN PATIENTS WITH TERMINAL GASTRIC CANCER BY TWO METHODS

目的:观察比较植入用缓释氟尿嘧啶腹腔给药和腹腔内热灌注氟尿嘧啶化疗治疗晚期胃癌恶性腹水患者的近期疗效、临床获益反应及毒副反应。方法:选择30例经病理组织学确诊的晚期胃腺癌腹水病人,随机分为两组,每组15例。植入用缓释氟尿嘧啶腹腔给药组:将按500mg/m2注入植入用缓释氟尿嘧啶,第14d再重复给药。热灌注化疗组:将5-FU1g溶于10%葡萄糖500mL中,加热至45°C,注入腹腔。第7d和第14d再重复给药。2周期治疗后评价疗效。结果:植入用缓释氟尿嘧啶给药组和腹腔热灌注组总有效率分别为66.7%和64.2%,两组比较无显著性差异(P>0.05)。临床获益率分别为73.37%(11/15)和71.4%(10/14),两者比较无统计学差异(P>0.05)。血液系统毒性比较无统计学意义(P>0.05)。非血液系统毒性两组的腹泻、肾功能损害、周围神经炎、口腔黏膜炎的发生率无统计学差异(P>0.05);恶心/呕吐、肝功能损害的发生率有统计学差异(P(0.05)。结论:两种方案治疗晚期胃癌恶性腹水疗效确切,均能显著改善病人的生活质量,两组对比均无明显差异。毒副作用可以耐受,安全性好,但恶心/呕吐和肝功能损害的发生率植入用缓释氟尿嘧啶腹腔给药组比腹腔内热灌注化疗组低。

Objective ：To observe the short -term efficency, clinical benefit response and toxicity of implanting fluorouracil sustained - release drug delivery compared with intra - abdominal peritoneal perfusion heat fluorouracil chemotherapy in the patients with terncinal gastric cancer and malignant ascites. Methods：30 cases of patients with confirmed terminal gastric adenocarcinoma with ascites by histopathology were divided into two groups randomly that were intraperitoneal implantation of sustained -release drug delivery fluorouracil group （IISRDF） and perfusion chemotherapy group （PC）. IISRDF group was implanted the sustained- release drug delivery fluorouracil as the dose of 500mg/m^2 , and repeated treatment was administered in forteehth day. PC group was intraperitoneal in-jection of the 5 - FU lg which was dissolved in the 10% glucose injection 500mL and heated to the temperature of 45℃. Repeated treatment was administered in the seventh day and forteenth day. The curative effect were evaluated between two grortgs after two cycles. Results：The total effective rate of IISRDF group and PC group were 66.7% and 64.2%, respectively. There was no significant difference （P 〉0.05）. Clinical benefit rate was 73.37% （11/15） and 71.4% （ 10/14）, repectively. There also was no significant difference between the two groups （ P 〉 0.05 ）. Comparison of hematological toxicity between the two groups was not significant （ P 〉 0.05 ）. Non - hematological toxicity , such as diarrhea, renal dysfunction, peripheral neuritis and the incidence of oral mucositis was no sig- nificant difference （P 〉 0.05 ）, but the incidence of nausea / vomiting and liver dysfunction had a significant difference （ P 〈 0.05） between two groups. Conclusion ： Both methods of treating terminal gastric cancer with malignant ascites are effective. There is no significant difference in the improvement of the life quality between two groups. Tolerable side effects can be endured and safety is good, but the incidence of nausea / vomiting and liver dysfunction of ⅡSRDF group is lower than the PC group.