腹腔热灌注化疗用于进展期结直肠癌术后辅助治疗的临床观察

Clinical observation of postoperative hyperthermic intraperitoneal chemotherapy for patients with progressive colorectal cancer

目的分析进展期结直肠肿瘤患者术后行腹腔热灌注的安全性与疗效。方法选取2013年7月-2014年7月解放军总医院普通外科收治的143例结直肠癌患者,收集完整临床资料,随机分为观察组和对照组,观察组72例,术后早期给予腹腔热灌注化疗联合常规静脉化疗;对照组71例,仅给予单纯静脉化疗,对比两组患者化疗不良反应发生率和术后并发症发生率等,随访汇总患者3年生存及转移复发情况。结果两组患者性别、年龄、原发肿瘤位置、肿瘤浸润深度、淋巴转移程度、TNM分期、病理类型等基本资料差异均无统计学意义。化疗不良反应:观察组胃肠反应(Ⅰ-Ⅱ41.7%,Ⅲ-Ⅳ13.9%)、骨髓抑制(Ⅰ-Ⅱ33.3%,Ⅲ-Ⅳ19.4%)、肝功能损害(Ⅰ-Ⅱ38.9%,Ⅲ-Ⅳ18.1%)等略高于对照组[胃肠反应(Ⅰ-Ⅱ39.4%,Ⅲ-Ⅳ15.5%)、骨髓抑制(Ⅰ-Ⅱ26.8%,Ⅲ-Ⅳ15.5%)、肝功能损害(Ⅰ-Ⅱ36.6%,Ⅲ-Ⅳ15.5%)](P均<0.05)。手术并发症:观察组出血率(9.7%)略低于对照组(9.9%),吻合口及残端瘘(9.7%vs 8.5%)、腹腔感染(13.9%vs11.3%)、肠梗阻(11.1%vs 8.5%)发生率略高于对照组,但差异均无统计学意义;观察组1年、2年、3年复发转移率依次为2.8%、6.9%、9.7%,分别小于对照组的11.2%、15.5%、21.1%,1年、2年、3年生存率依次为90.3%、80.6%、70.8%,均低于对照组的80.3%、64.8%、54.9%,差异均有统计学意义(P均<0.05)。结论相比单纯静脉化疗,腹腔热灌注化疗联合静脉化疗对于进展期结直肠癌术后患者更加安全有效,可降低复发转移率,延长患者生存期。

Objective To study the safety and efficacy of postoperative hyperthermic intraperitoneal chemotherapy in patients with progressive colorectal cancer. Methods Clinical data about 143 cases with progressive colorectal cancer underwent surgery in department of general surgery of Chinese PLA General Hospital from July 2013 to July 2014 were reviewed. Patients were randomly divided into observation group （n=72） and control group （n=71）. Patients in observation group received hyperthermic intraperitoneal chemotherapy combined with conventional intravenous chemotherapy, while patients in control group only received intravenous chemotherapy. The incidences of adverse reaction of chemotherapy and postoperative complications, 3-year overall survival and metastatic recurrence in patients of the two groups were compared. Results There was no statistically significant difference between the two groups in gender, age, primary tumor location, tumor infiltration depth, lymphatic metastasis, TNM staging, and pathological type. The incidences of adverse reaction of chemotherapy in observation group, including gastrointestinal reaction （Ⅰ - Ⅱ 41.7%,Ⅲ - Ⅳ 13.9%）, bone marrow suppression （ Ⅰ - Ⅱ 33.3%, Ⅲ - Ⅳ 19.4%）, liver function injury （ Ⅰ - Ⅱ 38.9%, Ⅲ - Ⅳ 18.1%）, were slightly higher than those of control group （ Ⅰ - Ⅱ 39.4%, Ⅲ - Ⅳ 15.5%; Ⅰ - Ⅱ 26.8%, Ⅲ - Ⅳ 15.5%; Ⅰ - Ⅱ 36.6%, Ⅲ - Ⅳ 15.5%, all P ＜ 0.05）. Complications in observation group, including bleeding, which was slightly lower than that of control group （9.7% vs 9.9%）, while leakage and fistula （9.7%）, abdominal cavity infection （13.9%）, intestinal obstruction （11.1%） were slightly higher than those of control group （8.5%, 11.3%, 8.5%）, but no statistical difference was found. The 1 year, 2-year, 3-year recurrence metastasis rates of observation group were 2.8%, 6.9%, 9.7%, and they were less than those of control group （11.2%, 15.5%, 21.1%） without significant difference . The 1-year, 2-year,3-year survival rates of the observation group were 90.3%, 80.6%, 70.8%, lower than those of control group （80.3%, 64.8%, 54.9%）, and the differences were statistically significant （All P ＜ 0.05）. Conclusion Compared with traditional intravenous chemotherapy, postoperative hyperthermic intraperitoneal chemotherapy combined with intravenous chemotherapy can reduce the recurrence rate and prolong the survival of patients with progressive colorectal cancer.