术中腹腔灌注化疗对T4期结直肠癌患者安全性及短期疗效的观察

Safety and short-term efficacy of intraoperative intraperitoneal infusion chemotherapy in patients with stage T4 colorectal cancer

目的探讨术中腹腔灌注化疗对T4期结直肠癌患者安全性及短期疗效的影响。方法选取2018年1月至2019年6月间锦州医科大学附属第一医院收治的100例T4期结直肠癌患者,采用随机数表法分为观察组和对照组,每组50例。两组患者均行常规腹腔镜根治手术治疗,围手术期均采用加速康复外科治疗方案,在此基础上,观察组患者术中采用腹腔灌注化疗。比较两组患者治疗前后肿瘤血清标志物水平、术后半年复发情况、术后不良反应及并发症发生情况。结果两组患者手术并发症、肠道功能恢复时间和术后住院时间比较,差异均无统计学意义(P>0.05)。两组患者术后化疗不良反应发生率比较,差异均无统计学意义(P>0.05)。手术前后,两组患者癌胚抗原(CEA)和血清糖链抗原(CA-199)水平比较,差异均无统计学意义(P>0.05)。术后6个月随访,观察组患者复发2例,对照组复发3例,差异无统计学意义(P>0.05)。结论T4期结直肠癌患者术中预防性行腹腔灌注化疗,并不会增加不良反应和术后并发症,对血清标志物浓度未见明显影响,对改善患者短期预后结局具有积极意义。

Objective To investigate the safety and short-term efficacy of intraoperative intraperitoneal perfusion chemotherapy in patients with stage T4 colorectal cancer.Methods A total of 100 patients were selected who underwent concurrent radical surgery for stage T4 colorectal cancer at First Affiliated Hospital of Jinzhou Medical University on January 1,2018 and June 1,2019.The random number table method was adopted to assign the patients into an observation group and a control group with 50 patients in each group.Laparoscopic radical operation was performed in both groups.Both groups underwent perioperative enhanced recovery after surgery(ERAS).In addition,patients in the observation group were given intraoperative intraperitoneal perfusion chemotherapy.The levels of serum tumor markers before and after treatment,recurrence within half a year after operation,and incidence of postoperative adverse reactions and complications was compared between the two groups.Results There was no significant difference in the incidence of operation-associated complications,time to recovery of intestinal function and length of hospital stay between the two groups(P>0.05).The difference in the incidence of postoperative adverse reactions was not significant between the two groups(P>0.05).There was no significant difference in the levels of carcinoembryonic antigen(CEA)and carcinoembryonic antigen-199(CA-199)between the two groups before and after the surgery(P>0.05).At 6 months after the operation,recurrence occurred in 2 patients in the observation group and 3 patients in the control group(P>0.05).Conclusion Intraoperative prophylactic intraperitoneal perfusion chemotherapy does not increase the toxicity,adverse reactions and postoperative complications and has no significant effect on the concentration of serum tumor markers,which has positive meaning in improving the short-term prognosis in patients with stage T4 colorectal cancer.