肝癌腹水腹腔化疗的临床研究

The Evaluation of the Efficacy of Intraperitoneal Chemotherapy on Advanced Stage of Liver Cancer with Tension Ascites

目的 探讨腹腔化疗对肝癌伴张力性腹水的疗效。方法 晚期肝癌伴张力性腹水患者 6 1例 ,随机分三组 ,A组 2 6例采用腹水超滤浓缩自体腹腔回输联合腹腔内化疗 ;B组 18例采用治疗性放腹水联合腔内化疗 ;C组 17例单纯治疗性放腹水。B超测定患者治疗前后腹水消退情况。结果 一疗程有效率为 :A组 5 7 7% ;B组4 4 4 % ;C组 11 9%。腹水超滤浓缩自体腹腔回输联合腹腔化疗明显改善患者营养状况、肾功能、肾钠排泄及血浆肾素 -血管紧张素 -醛固酮代谢。结论 腹腔化疗对于肝癌伴张力性腹水具有一定的疗效 ,腹水超滤浓缩自体腹腔回输联合腹腔内化疗是治疗肝癌伴张力性腹水的一种安全、可靠。

Objective To explore curative effect of intraperitoneal chemotherapy to treat patients with tension ascites caused by advanced stage of liver cancer. Methods 61 patients with tension ascites caused by advanced stage of liver cancer were divided randomly into three groups, patients in group A (n=26) were treated by ultrafiltration ascites and peritoneal reinfusion (A-P) combined with intraperitoneal chemotherapy; patients in B group (n=18) were treated by paracentesis and intravenous albumin infusion combined with intraperitoneal chemotherapy; patients in group C (n=17) were treated by paracentesis and intravenous albumin infusion. Clinical situation, biochemical alteration, sodium metabolism and RAAS metabolism were observed before and after treatment.Results The findings revealed that definite clinical amelioration in all patients. Patients in three groups, biochemical examinations were improved during 24h after treatment, including of endogenous creatinine clearance rate and urine sodium output. But in group B and C, the biochemical examinations returned to the former levels and the levels of serum albumin was markedly reduced during 72h after treatment. The short-term effective rate on postoperative ascites in group A, B, C were 57.7%, 44.4% and 11.9% respectively.Conclusion A-P associated with intraperitoneal chemotherapy is an effective and safe therapy for patients with tension ascites caused by advanced stage of liver cancer.