盆腔热灌注化疗对大肠癌根治性治疗的影响及意义

Impact and Significance of Intrapelvic Hyperthermic Chemoperfusion on the Radical Resection of Colorectal Carcinoma

为研究盆腔不同温度热灌注化疗对进展期大肠癌的疗效及其预防术后早期肿瘤局部复发的作用，本研究将行根治性手术治疗的174例直肠癌患者分成3组，即单纯灌注组（低渗常温灌注，简称单灌组，60例）、温化灌注组（低渗温热灌注化疗，简称温化组，57例）和热化灌注组（低渗高热灌注化疗，简称热化组，57例），其中温化组和热化组统称为温热组。单灌组用常温（24℃～27℃）无菌蒸馏水进行盆腔灌注；温热组将5氟尿嘧啶（5FU）2．0g和顺铂（DDP）80mg稀释加温后进行盆腔灌注。测定并对比各组手术前后血清中癌胚抗原（CEA）、糖蛋白抗原199（CA199）和恶性肿瘤特异性生长因子（TSGF）的含量，以及术前及盆腔灌注后腹水中CEA的含量。结果显示，单灌组盆腔灌注后腹水CEA含量呈上升趋势（P〈0．05），而温热组术后腹水CEA含量明显降低（P〈0．05），且热化组术后CEA含量明显低于温化组（P〈0．01）。单灌组术后血清CEA、CA199、TSGF3项指标回升幅度较温热组明显（P〈0．01），而温化组与热化组比较差异无统计学意义（P〉0．05）。结果表明，进展期大肠癌根治术中行盆腔低渗热灌注化疗可显著降低患者相关肿瘤指标含量，清除、杀灭术中脱落的肿瘤细胞，防止肿瘤早期局部复发，近期疗效肯定，对提高患者生存率和生存质量意义重大。

The objective of the study was to observe the impact of intrapelvic hyperthermic chemoperfusion at different temperature on the therapeutic efficacy and the early postoperative local recurrence in advanced colorectal carcinoma. One hundred and seventy four patients who had undergone radical resection of colorectal carcinoma were divided into 3 groups, patients in group 1 underwent low osmotic pressure, common temperature chemoperfusion（ n =60）,patients in group 2 underwent low osmotic pressure and lukewarm chemoperfusion（ n =57）,and patients in group 3 underwent low osmotic pressure hyperthermic chemoperfusion（n =57）. Patients in group 1 received aseptic distilled water（24℃-27℃） in the intrapelvic perfusion,while patients in group 2 and 3 5 FU（2.0g） and DDP （80mg）diluted and warmed in the intrapelvie perfusion. Carcinoembryonic antigen（CEA）,carbohydrate antigen 199（CA199） and tumor specific growth factor（TSGF） in the serum were measured and compared both preoperatively and postoperatively. Also, CEA in the ascites was measured before and after intrapelvic perfusion. As resuhs,CEA in the ascites rose in group 1（ P 〈0.05） ,that lowered in group 2 and 3（ P 〈0.05） ,and that was much lower in group 3 than in group 2（ P 〈0.01） ;while CEA,CA199 and TSGF in the serum rose more markedly in group 1 than in group 2 and 3（ P 〈0.01） ,while there was no statistical significance in CEA,CA199 and TSGF in the serum between group 2 and 3（ P 〈0.05）. It is suggested that intrapelvic hyperthermic chemoperfusion during radical resection treatment of advanced eoloreetal carcinoma can markedly lower contents of relative turner index,clear kill the exfoliated cancer cells during operation and prevent local and early recurrence,and the therapeutic efficacy in the short time is positive, and has important significance to raise survival rate and survival quality of patients.