雷替曲塞等化疗药物低剂量动脉灌注治疗胃癌术后并发恶性肠梗阻

Arterial infusion chemotherapy with low dosage of raltitrexed for postoperative malignant bowel obstruction in patients with gastric cancer

目的探讨雷替曲塞等小剂量化疗药物介人性动脉灌注对胃癌术后腹腔转移致恶性肠梗阻的疗效。方法 42例胃癌术后伴不完全性肠梗阻患者,经肠系膜上动脉或加腹腔动脉、肠系膜下动脉等插管,灌注低剂量化疗药物,药物用量为雷替曲塞2 mg,奥沙利伯50~100 mg,多西他赛20~40 mg,化疗周期为每3~4周动脉灌注1次。本组病例至少灌注1次,最多7次。对照组42例给予内科姑息治疗,未给予化疗药物。结果介人化疗后肠梗阻缓解有效率为80.95%（34/42例）;对照组肠梗阻缓解有效率为42.85%（18/42例）,两组相比差异显著（P〈0.01）。介入化疗组排气、排便及腹痛腹胀的缓解时间均短于对照组,肠道通畅总维持时间长于对照组,两组相比统计学差异均显著。介人化疗组生存时间为2~36个月,中位生存时间5个月;对照组平均生存期为（2.69±2.25）个月,中位生存时间为3个月,两组生存时间统计学差异非常显著（P〈0.01）。介入治疗组对腹水治疗的总有效率为76.0（19/25）,也高于对照组（P〈0.01）。介入治疗组治疗后KPS评分提高,ECOG评分下降。结论小剂量化疗药物动脉灌注对胃癌术后腹腔转移致肠梗阻副作用小,能在短期内明显缓解癌性肠梗阻症状,肠道通畅维持时间长,并能有效控制伴随的腹水症状,延长生存时间,提高生活质量,尤其适用于老年及体质虚弱者。

Objective To evaluate the efficacy of arterial infusion chemotherapy with low dosage of raltitrexed in the treatment of postoperative malignant bowel obstruction in patients with gastric cancer.Methods Forty-two gastric cancer patients with incomplete postoperative bowel obstruction were included in the treatment group.The treatment group received arterial infusion chemotherapy by superior mesenteric artery and coeliac artery,or inferior mesenteric artery： raltitrexed,2 mg,oxaliplatin,50-100 mg,docetaxel,20-40 mg,once every 3-4 weeks.Every patient was given arterial infusion chemotherapy minimum once,maximum 7 times.The 42 patients in the control group received a palliative medicine treatment without chemotherapy.Results The remission rate of bowel obstruction was 80.95%（34/42） in the treatment group and 42.85%（18/42） in the control group.The difference of the two groups was statistically significant（P〈0.01）.The relief time of flatulence,defecate,abdominal pain and abdominal distension in the treatment group was shorter than in the control group.The difference was statistically significant.The survival time of the treatment group ranged from 2 to 36 months with a median survival time of 5 months.The survival time of the control group ranged was 2.69±2.253 months with a median survival time of 3 months.The difference of survival time of the two groups were statistically significant（P〈0.01）.The KPS score improved and ECOG score decreased in the treatment group after treatment.Conclusion The arterial infusion chemotherapy with low dosage of raltitrexed is effective and safe in the treatment of malignant bowel obstruction in patients with gastric cancer after operation.It can ease symptoms of bowel obstruction in a short time,keep bowel tract unobstructed longer,effectively control ascites,prolong the survival time and improve the quality of life,especially of the elderly and physical weak patients.