T_3以上结肠癌腹腔镜根治术后雷替曲塞联合奥沙利铂进行预防性腹腔热灌注化疗的临床研究

Clinical study of raltitrexed plus oxaliplatin preventive hyperthermic intraperitoneal perfusion chemotherapy after laparoscopic radical resection in patients with stage T_3 above colon cancer

目的观察T3以上结肠癌腹腔镜根治术后雷替曲塞联合奥沙利铂进行预防性腹腔热灌注化疗(HIPEC)的安全性及短期疗效。方法选取2014年10月至2015年10月该院胃肠外科收治的病理诊断T3以上结肠癌患者61例,随机分为试验组(19例)、对照1组(22例)和对照2组(20例),试验组术后使用雷替曲塞联合奥沙利铂进行HIPEC,隔2天1次,共3次,对照1组术后单用奥沙利铂,对照2组术后无特殊处理,三组患者术后4周开始进行静脉化疗(奥沙利铂、亚叶酸钙联合5-氟尿嘧啶方案)。比较试验组和对照1组患者进行HIPEC期间生命体征变化,三组患者治疗前后肿瘤标志物[血清癌胚抗原(CEA)、血清糖链抗原19-9(CA19-9)]变化,术后并发症发生情况,术后1、2年复发率及生存率等。结果试验组和对照组1组患者进行HIPEC治疗期间心率、呼吸、血压、体温变化比较,差异均无统计学意义(P>0.05)。试验组患者治疗后CEA、CA19-9水平较对照1组和对照2组明显降低,差异均有统计学意义(P<0.05);三组患者腹痛、腹胀发生率比较,差异均有统计学意义(P<0.05);三组患者1年生存率及复发率比较,差异均无统计学意义(P>0.05),2年复发率及生存率比较,差异均有统计学意义(P<0.05)。结论雷替曲塞联合奥沙利铂进行HIPEC安全、可靠,且较单用奥沙利铂效果更好。

Objective To observe the safety and short-term curative effect of raltitrexed plus oxaliplatin preventive hyperthermic intraperitoneal perfusion chemotherapy（HIPEC）in the patients with stage T3 above colon cancer.Methods A total of 61 cases of pathologically diagnosed stage T3 above colon cancer in this hospital from October 2014 to October 2015 were selected and randomly divided into the experimental group（19 cases）,control group 1（22 cases）and control group 2（20 cases）.The experimental group used raltitrexed plus oxaliplatin HIPEC,once every other day,total three times.The control group 1was treated with single oxaliplatinr HIPEC,while no special treatment was performed after operation in the control group 2.Intravenous chemotherapy（FOLFOX）was initiated in three groups at postoperative 4 weeks.Then the changes of vital signs during treatment,level of tumor marker serum cancer embryo antigen（CEA）,serum sugar chain antigen 19-9（CA19-9）,occurrence situation of postoperative complications,recurrence rate at postoperative 1,2 year and survival rate were compared among the three groups.were no statistically significant differences in the changes of heart rate,respiratory,blood pressure and liver and kidney function during the treatment among the three groups（P〈0.05）.The CEA and CA19-9 levels after treatment in the experimental group were significantly lower than those in the control group 1 and the control group 2,the differences were statistically significant（P〈0.05）;the occurrence rates of abdominal pain and abdominal distension had statistical difference among 3 groups（P〈0.05）.There was no statistical difference in 1-year survival rate and 1-year recurrence rate among the three groups（P〉0.05）.The 2-year recurrence rate and 2-year survival rate had statistical difference（P〈0.05）.Conclusion Raltitrexed plus oxaliplatin HIPEC is safe and reliable,and has a better curative effect than oxaliplatin alone.