术后腹腔灌注化疗对T_4期结直肠癌患者的治疗效果和安全性探讨

Investigation of efficacy and safety of postoperative intraperitoneal chemotherapy for patients with stage T_4 colorectal cancer

目的探讨术后早期腹腔热灌注化疗在T_4期结直肠癌患者中的治疗效果,分析其安全性。方法纳入本院收治的T_4期结直肠癌患者102例,随机将其分为观察组(根治性手术+术后腹腔热灌注化疗)和对照组(根治性手术+术后静脉化疗),每组各51例。分析治疗前、后患者免疫功能变化情况,通过观察毒副反应发生率评估化疗安全性,并分析两组患者3年内存活率、复发率、转移率。结果观察组治疗后的CD8^+水平低于对照组,CD4^+/CD8^+高于对照组,组间差异均有统计学意义(均P<0.05)。观察组骨髓抑制、腹痛发生率分别为11.76%、5.88%,低于对照组(27.45%、19.61%),组间差异均有统计学意义(均P<0.05)。观察组3年内的总生存率高于对照组,复发率、转移率低于对照组,差异均有统计学意义(均P<0.05)。结论术后早期腹腔热灌注化疗较传统静脉化疗对T_4期结直肠癌患者的免疫功能影响更小,副作用较轻,且术后3年的生存情况更优,具有较好的临床应用价值。

Objective To investigate the therapeutic effect and safety of early postoperative intraperitoneal hyperthermic chemotherapy in patients with T_4 stage colorectal cancer. Methods 102 patients with stage T_4 colorectal cancer treated in our hospital were randomly assigned to treatment group（radical surgery plus postoperative intraperitoneal hyperthermic chemotherapy） and control group（radical surgery plus traditional postoperative intravenous chemotherapy）, with 51 cases in each group. Changes of immune func tion before and after treatment were analyzed. The safety of chemotherapy was evaluated by incidence of side effects. Survival rate, recurrence rate and metastasis rate in 3 years were analyzed. Results The CD8~＋ level was lower and CD4~＋/CD8~＋ higher in the treatment group than the control group with significant between-group difference（P〈0.05）.The incidence of bone marrow suppression and abdominal pain was 11.76% and 5.88%, respectively in the treatment group, which was lower than in the control group（27.45% and 19.61%, respectively）, with significant between-group difference（P〈0.05）. The survival rate, recurrence rate and metastasis rate within 3 years were 70.59%, 21.57% and 19.61%, respectively, in the treatment group. The survival rate was higher and the recurrence and metastasis rate lower in the treatment group than in the control group, with significant between-group difference（P〈0.05）. Conclusion Compared with traditional postoperative intravenous chemotherapy, early intraperitoneal hyperthermic perfusion chemotherapy has less impact on the immune function of the patients with colorectal center. It has less side effect and better 3-year survival rate. It has good value for clinical application.