结肠癌腹腔内淋巴化疗的临床研究

Intraperitoneal lymphatic chemotherapy for colonic cancer

目的 观察结肠癌患者术前麻醉诱导期联合应用善宁、卡铂对结肠淋巴结铂浓度的影响 ,以及预防性腹腔内淋巴化疗对术后腹膜后淋巴结转移的影响。 方法 182例结肠癌患者随机分为预防性腹腔内淋巴化疗组 (90例 )和对照组 (92例 ) ,均行根治性切除术。淋巴化疗组患者 ,在术前麻醉诱导期开始联合应用善宁 (0 1mg ,2次 )、卡铂 (2 0 0mg) ;对照组仅用卡铂 (2 0 0mg)腹腔内化疗 ,比较 2组患者术中结肠边缘淋巴结、中间淋巴结以及中央淋巴结铂浓度。 2组患者术后继续腹腔内淋巴化疗或腹腔内化疗 ,以腹部CT检查比较其对术后腹膜后淋巴结转移的影响。 结果 腹腔内淋巴化疗组患者用药 2、3h后 ,边缘淋巴结、中间淋巴结以及中央淋巴结铂浓度明显高于对照组 ;术后腹膜后淋巴结转移率明显低于对照组 ,差异均有极显著性意义 (P <0 0 1)。 2组门静脉血液铂浓度、转移淋巴结与未转移淋巴结之间铂浓度差异均无显著性意义 (P >0 0 5 )。 结论 联合应用善宁、卡铂可明显提高结肠淋巴结铂浓度 ,减少术后淋巴转移 ,是一种有效的腹腔内淋巴化疗方式。

Abstracts[WT5”BZ] To evaluate the effect of intraperitoneal lymphatic chemotherapy with carboplatin and sandostatin on colonic carcinoma and abdominal lymphatic metastasis in patients after radical resection. [WT5”HZ]Methods[WT5”BZ] Patients with colonic cancer were divided into two group: abdominal lymphatic chemotherapy group and control group. The lymphatic chemotherapy group was treated at the introduction stage of anesthesia with carboplatin(200 mg) injected intraperitoneally and sandostatin (0 1 mg×2) injected subcutaneously, whereas the control group was just treated with carboplatin(200 mg) injected intraperitoneally. The platinum levels in abdominal lymphatic nodes were monitored during operation. The two groups were unintermitently given intraperitoneaol lymphatic chemotherapy or intraperitoneal chemotherapy. Retroperitoneal lymphatic metastasis was evaluated in each patient by abdominal CT scan after operation. [WT5”HZ]Results[WT5”BZ] The platinum levels in abdominal lymphatic nodes increased more significantly at 2, 3 hours in the lymphatic chemotherapy group than in the control group( P <0 01). There was no difference in the platinum levels of the portal vein between the two groups, and also no difference in the platinum levels between the lymphatic nodes with or without metastasis. The rates of retroperitoneal lymphatic metastasis after resection were significantly lower in the lymphatic chemotherapy group control group( P <0 01). [WT5”HZ]Conclusion[WT5”BZ] Intraperitoneal administration of carboplatin combined with sandostatin may elevate the platinum levels in the abdominal lymphatic nodes and reduce the abdominal lymphatic metastasis after radical resection of colonic cancer. It is an effective method for intraperitoneal lymphatic chemotherapy. [WT5”HZ]