腹腔热灌注化疗治疗胃癌恶性腹水的临床疗效

Clinical effects of hyperthermic intraperitoneal chemotherapy for gastric cancer with malignant ascites

目的:探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗胃癌恶性腹水的临床疗效.方法:按照随机数字表法将70例患者均分为实验组和对照组,每组35例,实验组患者给予HIPEC联合热疗治疗,对照组患者给予常温腹腔灌注化疗,比较两组患者临床疗效、治疗前后Kamofsky评分变化情况以及不良反应发生情况,记录实验组患者HIPEC治疗过程中不同时间点温度和生命体征变化情况.结果:实验组患者总有效率显著高于对照组(77.14%vs 37.14%),差异具有统计学意义(P<0.05);两组患者治疗后Kamofsky评分均显著升高,与治疗前比较(77.92分±6.83分vs 54.44分±5.47分,62.08分±6.17分vs 53.89分±5.56分),差异具有统计学意义(P<0.05);实验组治疗后Kamofsky评分显著高于对照组(77.92分±6.83分vs 62.08分±6.17分),差异具有统计学意义(P<0.05);实验组患者HIPEC治疗过程中各时间点体表温度、鼓膜温度、直肠温度、血压、心率、呼吸、血氧饱和度等均在正常范围内,无明显变化(36.18℃±0.42℃vs 36.42℃±0.27℃vs 37.13℃±1.72℃,35.66℃±0.23℃vs 35.94℃±0.37℃vs 36.60℃±0.22℃,36.34℃±0.12℃vs 36.64℃±0.27℃vs 37.10℃±0.30℃,117 mmHg±6.2 mmHg vs 116 mmHg±6.5 mmHg vs 116 mmHg±6.4 mmHg,62 mmHg±4.9 mmHg vs 69 mmHg±6.8 mmHg vs 72 mmHg±5.3 mmHg,68次/min±4.3次/min vs 72次/min±5.3次/min vs 73次/min±4.5次/min,14次/min±2.5次/min vs 13次/min±1.8次/min vs 14次/min±1.7次/min,98%±1.8%vs 97%±0.9%vs 98%±1.3%),差异无统计学意义(P>0.05);实验组患者脂肪硬结发生率显著高于对照组(14.29%vs 0.00%),差异具有统计学意义(P<0.05).结论:HIPEC可显著改善患者Kamofsky活动状态评分,安全性高,不明显增加不良反应,疗效显著,是治疗胃癌恶性腹水的优选方案.

AIM： To assess the clinical effects of hyperthermic intraperitoneal chemotherapy（HIPEC） in the treatment of gastric cancer with malignantascites.METHODS： Seventy patients with gastric cancer with malignant ascites were randomly divided into either a study group or a control group. The study group was treated by HIPEC combined with thermal therapy, and the control group was treated by non-hyperthermic peritoneal perfusion chemotherapy. The clinical effects, Kamofsky score and adverse reactions were compared for the two groups. The temperature and vital signs at different points of HIPEC were recorded.RESULTS： The total effective rate was significantly higher in the experiment group than in the control group（77.14% vs 37.14%, P 0.05）. Posttreatment Kamofsky scores for the two groups were significantly higher than prior-treatment values（77.92 ± 6.83 vs 54.44 ± 5.47, 62.08 ± 6.17 vs 53.89 ± 5.56, P 0.05）. Posttreatment Kamofsky score was significantly higher in the experiment group than in the control group（77.92 ± 6.83 vs 62.08 ± 6.17, P〈0.05）. There were no significant difference in the shell temperature, tympanic temperature, rectal temperature, blood pressure, heart rate, breath, or oxyhemoglobin saturation for the experiment group at different time points（36.18 ℃ ± 0.42 ℃ vs 36.42 ℃ ± 0.27 ℃ vs 37.13 ℃ ± 1.72 ℃, 35.66 ℃ ± 0.23 ℃ vs 35.94 ℃ ± 0.37 ℃ vs 36.60 ℃ ± 0.22 ℃, 36.34 ℃ ± 0.12 ℃ vs 36.64 ℃ ± 0.27 ℃ vs 37.10 ℃ ± 0.30 ℃, 117 mmHg ± 6.2 mmHg vs 116 mmHg ± 6.5 mmHg vs 116 mmHg ± 6.4 mmHg, 62 mmHg ± 4.9 mmHg vs 69 mmHg ± 6.8 mmHg vs 72 mmHg ± 5.3 mmHg, 68/min ± 4.3/min vs 72/min ± 5.3/min vs 73/min ± 4.5/min, 14/min ± 2.5/min vs 13/min ± 1.8/min vs 14/min ± 1.7/min, 98% ± 1.8% vs 97% ± 0.9% vs 98% ± 1.3%, P〉0.05）. The rate of fatty scleroma for the experiment group was significantly higher than that for the control group（14.29% vs 0.00%, P 0.05）.CONCLUSION： HIPEC can improve Kamofsky score and has high safety in patients with gastric cancer with malignant ascites.