进展期胃癌术中腹腔热灌注化疗临床研究

Clinical trial of intra-operative hyperthermic intraperitoneal chemotherapy for advanced gastric cancer

目的探讨进展期胃癌术中腹腔热灌注化疗对防治腹膜转移的疗效及安全性。方法对40例进展期胃癌患者进行回顾性分析,热化疗组（实验组）20例行根治性手术联合术中腹腔热灌注化疗（H IPEC）,采用奥沙利铂350 mg溶于右旋糖酐4000 m l中,加热至41.5℃~42.5℃腹腔内循环灌注40~60 m in;选择同期单纯根治性手术治疗的20例胃癌患者作为对照组,对比分析两组患者的临床指标及预后。结果热化疗组仅少数病例治疗后出现短期血压降低、心率增快及肝肾功能、凝血功能指标异常,两组并发症发生率无明显差异;术后腹腔种植转移率热化疗组为5.0%（1/20）,对照组15.0%（3/20）;1,2年生存率热化疗组分别为90.0%（18/20）和75.0%（15/20）,对照组分别为80.0%（16/20）和60.0%（12/20）。结论 H IPEC可有效防治腹膜转移、提高生存率,且并发症少,可作为进展期胃癌术中的辅助治疗。

Objective To explore the efficacy and safety of intra-operative hyperthermic intraperitoneal chemotherapy（HIPEC） in the control of peritoneal metastasis in patients with advanced gastric cancer.Methods A retrospective analysis was performed for 40 patients with advanced gastric cancer.Twenty cases underwent radical operation plus intra-operative HIPEC in the HIPEC（experiment） group.Oxaliplatin 350mg was dissolved in dextran 4000ml and heated to 41.5-42.5℃ for an intra-peritoneal circulating perfusion of 40-60 minutes.The control group was made up of 20 patients with advanced gastric cancer undergoing radical operation alone during the same period.The clinical parameters and prognoses of two patient groups were compared and analyzed.Results As compared with the control group,only few cases in the HIPEC group had a transient post-therapeutic onset of hypotension,tachycardia and abnormal parameters of hepatic,renal and coagulation functions.The incidence of complications had no marked difference between 2 groups.The post-operative metastatic rates of peritoneal seeding were 5.0%（1/20） and 15.0%（3/20） in the HIPEC and control groups respectively.The 1-,2-year survival rates were 90.0%（18/20）,75.0%（15/20） vs.80.0%（16/20）,60.0%（12/20） respectively.Conclusion HIPEC can effectively control peritoneal metastasis,boost survival rate and lower complication rate,and may be adopted as an adjuvant intra-operative therapy for advanced gastric cancer.