超声引导下腹腔内化学疗法对进展期胃癌癌性腹水患者疗效及免疫调控作用

Therapeutic and immunomodulating effects of ultrasound-guided intraperitoneal chemotherapy on advanced gastric cancer patients with cancerous ascites

目的观察超声引导下腹腔内化学疗法(化疗)对进展期胃癌伴癌性腹水患者的疗效及其免疫调控作用。方法进展期胃癌癌性腹水60例随机分为治疗组和对照组,治疗组行超声引导下腹腔化疗(EAP方案,VP_(16)100 mg/m^2+表阿霉素60 mg/m^2+卡铂200 mg/m^2),对照组为EAP静脉化疗。结果治疗后,治疗组与对照组比较,肿瘤体积、癌性腹水治疗有效率、生活质量、免疫功能、中位生存期以及生存率均显著改善,不良反应发生率显著降低。结论超声引导下腹腔化疗可显著提高胃癌患者肿瘤近期有效率和癌性腹水近期有效率,并可显著改善生活质量,不良反应低,延长非手术胃癌患者的中位生存期和提高生存率,这可能与治疗后改善了免疫调控功能有关。

[ Abstract] Objective To study the therapeutic efficacy of ultrasound -guided intraperitoneal chemotherapy in advanced gas- tric cancer patients with malignant aseites and its effect on their immune function. Methods Sixty patients with advanced gastric an- trum cancer were divided randomly into the treatment group （intraperitoneal EAP regimen） and control group （ intravenous EAP regi- men）. EAP chemotherapy consisted of VP16 100 mg/m2 ＋ Epirubicin 60 mg/m2 ＋ Carboplatin 200 mg/m2. Results After the treat- ment, compared with the control group, the tumor volume, therapeutic effect on ascites, Karnofsky score, median survival time, sur- vival rate and immune function in the treatment group were significantly ameliorated, and the incidence of side effects was significantly decreased. Conclusions The high- dose intraperitoneal chemotherapy used in advanced gastric antrum cancer has good therapeutic efficacy by significantly improving the life quality, extending the length of survival, increasing the survival rate in patients with ad- vanced gastric antrum cancer, and reducing drug side -effect. This may be due to the up -regulation of the immune regulating factors such as IL - 2, TNFa, and IFN-y and down - regulation of the immune inhibitory factor sIL - 2R after the high - dose intraperitoneal chemotherapy.