胃癌靶向注射治疗的临床观察

Clinical Observation of Targeting Injection Treatment in Gastric Cancer

目的探讨术中靶向注射治疗对胃癌术后腹腔种植转移的影响。方法对46例进展期胃癌根治性切除术后患者随机分成两组。治疗组于胃癌D2手术完成、关腹之前,将化疗药物丝裂霉素6～10mg,替加氟0.5～1g溶于蒸馏水2000ml中,加温至42℃～44℃,然后沿淋巴引流方向靶向注射,保留15～30min后关腹;对照组在完成胃癌D2手术后,术中用蒸馏水2000ml加温至42℃～44℃,灌入腹腔常规冲洗保留15～30min后关腹;两组病例均在术后2周,肝、肾功能、外周血（WBC）正常后开始接受TFL方案静脉化疗：注射用盐酸拓扑替康1.2mg/m2,ivgtt,d1,替加氟1g/m2,ivgtt,d1-5,注射用亚叶酸钙0.2g,ivgtt,d1-5,q21～28d为一周期,2～3次为1疗程。化疗中并发症均给予对症处理。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个月复发转移无显著性差异;18、24个月的复发转移率：治疗组分别为4例占17.4%,6例占26.1%;对照组分别为6例占26.1%,10例占43.5%;两组差异有显著性P〈0.05。2年内术后复发率分别为10.9%和23.9%,差异有显著性（P〈0.05）。结论术中靶向注射治疗对胃癌根治术后腹腔种植转移复发有较好的防治作用。

Objective To explore the curative effect of targeting injection treatment to treat advanced gastric carcinoma. Methods 46 patients with advanced gastric cancer were randomly divided into two groups：the treatment group received MMC 6-10mg, Tegafur 0.5-1g were added into 2000ml distilled water, heated to 42℃ -44℃ injected by targeting from lymph direction;Patients in Group 2 received only intraperitoneal perfusion chemotherapy of distilled water. Patients in two Group Sreceived intravenous chemotherapy of TFL （Topotecan 1.2 mg/m-2 d1, tegafur 1g/m 2 d1-5, LV 200 mg/m-2 （ivdrip,2 h） d1-5, The treatment every 3-4 weeks as a circle. Results The 6 and 12 month reeuration rates between the two groups were no remarkable difference （P〉0.05）.The 1.6-, and2- year recnration rates were 17.4% （4/23） and 26.1% （6/23） in Group 1, and 26.1% （6/23） and 43.5% （10/23） in Group 2. There was remarkable difference between the two groups （P〈0.05）. Conclusion Targeting injection treatment combined with intravenous TFL chemotherapy is an advisable treatment for patients with advanced gastric cancer who have undergone radical surgery.