胃肠道癌术中腹腔内温热化疗临床适应证的探讨

Establishing Clinical Indications of Intraoperative Peritoneal Hyperthermic Chemotherapy for Gastrointestinal Malignancy

目的:探讨胃肠道癌术中腹腔内温热化疗(IPHC)防治腹膜转移的临床适应证.方法:78例胃癌,5例结肠癌,剖腹后先收集腹水或腹腔冲洗液行细胞学或病理学检查,寻找游离癌细胞,并与肿瘤生物学特性进行单因素和多因素判别分析.结果:腹腔内游离癌细胞阳性率同腹膜转移、浆膜侵犯、TNM分期、浆膜侵犯面积、淋巴转移、腹水、Borrmann分型等因素有关(P<0.05),其中前两者为独立影响因素(P<0.0001).结论:IPHC的临床适应证为:①肉眼可见腹膜转移灶或癌性腹水;②术后腹膜转移;③腹腔冲洗液中发现游离癌细胞;④肿瘤侵及浆膜.

To establish the clinical indications of intraoperative peritoneal hyperthermic chemotherapy(IPHC) for gastrointestinal malignancy. Methods: Ascites or peritoneal lavage fluid collected before exploration were examined to detect free cancer cells(FCC) by cytological or pathological methods. The relationship between FCC and biological behavior of the malignancy then subjected to mono- and multi-variate analysis. Results: FCC was found to be closely related to many factors such as serosal invasion, peritoneal metastasis, lymphatic metastasis, ascites, TNM staging and Borrmann's type (P<0.05). Conclusions: The indications of IPHC are as follows: 1. Macroscopic peritoneal metastasis or malignant ascites; 2. Postoperative peritoneal recurrence; 3. Free cancer cell found in peritoneal lavage; 4. Tumor having invaded the serosa.