循环式腹腔热灌注化学治疗在T4期胃癌D2根治术后的应用

Application of continuous hyperthermic peritoneal perfusion chemotherapy in T4 gastric cancer after D2 radical surgery

目的探讨T4期胃癌患者D2根治术后早期行循环式腹腔热灌注化学治疗(CHPPC)的可行性、安全性及临床效果。方法 86例T4期胃癌患者分为CHPPC组和对照组,每组43例。CHPPC组患者于术后第1天开始行CHPPC,每日1次,共3 d;术后1个月内行第1次全身静脉化学治疗,方案为m FOLFOX6。对照组患者于术后1个月内行第1次全身静脉化学治疗,化学治疗方案同CHPPC组。比较2组患者的不良反应、并发症、术后复发率、生存率及生存质量。结果 2组患者均无手术相关死亡,均未出现切口感染、吻合口瘘、粘连性肠梗阻等术后并发症。2组患者骨髓抑制、恶心、呕吐、肝功能损害发生率比较差异均无统计学意义(P>0.05)。CHPPC组43例患者术后CHPPC均顺利完成,术后1、2 a复发率显著低于对照组(P<0.05),术后2 a生存率显著高于对照组(P<0.05),但2组患者术后1 a生存率比较差异无统计学意义(P>0.05),生存质量显著高于对照组(P<0.05)。结论 T4期胃癌患者D2根治术后早期行CHPPC安全可行,可显著降低腹腔内复发率,提高患者中远期生存率及生存质量,且无明显毒副作用。

Objective To explore the feasibility,safety and clinical effect of early postoperative continuous hyperthermic peritoneal perfusion chemotherapy（ CHPPC） for T4 gastric cancer after D2 radical surgery. Methods A total of 86 patients with T4 gastric cancer were divided into CHPPC group and control group,43 cases in each group. The patients in CHPPC group were treated with CHPPC from the first day after operation,once a day for 3 days. Then,the patients in CHPPC group were treated with the first intravenous chemotherapy of m FOLFOX6 within one month after operation. The patients in control group also received the first intravenous chemotherapy of m FOLFOX6 within one month after operation. The adverse effects,complications,postoperative recurrence rate,survival rate and survival quality were compared between the two groups. Results There was no operative death in the two groups. There was no postoperative incision infection,anastomotic fistula and adhesive intestinal obstruction in the two groups. There was no significant difference in bone marrow depression,nausea,vomiting and liver dysfunction between the two groups（ P〈0. 05）. The postoperative CHPPC was successful in 43 patients in CHPPC group. The 1-and 2-year recurrence rate in CHPPC group were significantly lower than those in control group（ P〈0. 05）. The2-year survival rate in CHPPC group was significantly higher than that in control group（ P〈0. 05）. But there was no significant difference in 1-year survival rate between the two groups（ P〈0. 05）. The survival quality in CHPPC group was significantly higher than that in control group（ P〈0. 05）. Conclusion The early postoperative CHPPC for T4 gastric cancer after D2 radical surgery is feasible and safe,which can significantly decrease the local recurrence rate in peritoneal cavity,increase the medium-term and long-term survival rate,improve the survival quality,and no obvious adverse effects.