雷替曲塞用于腹膜假黏液瘤肿瘤细胞减灭术后腹腔热灌注化疗的短期疗效及安全性分析

Analysis of short-term efficacy and safety of raltitrexed in hyperthermic intraperitoneal chemotherapy after cytoreductive surgery for pseudomyxoma peritonei

目的:观察雷替曲塞用于腹膜假黏液瘤(pseudomyxoma peritonei, PMP)肿瘤细胞减灭术(cytoreductive surgery, CRS)后腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy, HIPEC)的短期疗效及安全性。方法:回顾性分析我院自2019年01月至2020年03月接受CRS联合HIPEC治疗的PMP患者,根据术后灌注药物方案是否应用雷替曲塞分为观察组和对照组。观察组术后第1次灌注药物为雷替曲塞(4 mg),第2~5次灌注药物为5-氟尿嘧啶(5-FU)(1 g);对照组术后5次灌注药物均采用5-FU(1 g)。比较两组患者术后一般情况、手术并发症发生率、排气时间、住院时间及两组患者手术前后血常规(WBC、PLT)、肝功能(ALT、AST)、肾功能(Cr)变化情况。结果:研究期间接受CRS及HIPEC治疗的患者共86例,其中观察组和对照组分别为39例和47例。两组基线资料一致(P>0.05)。两组间术后出血、肠瘘、胸腔积液、切口感染等并发症发生率比较无统计学差异(P>0.05)。化疗相关不良反应显示对照组腹痛发生率较观察组多(P=0.044),其余不良反应如恶心、呕吐、乏力、发热3日以上等两组比较均无统计学差异(P>0.05)。两组患者手术前后血液学检查结果变化无统计学差异(P> 0.05)。结论:雷替曲塞用于PMP CRS后HIPEC,不增加术后并发症,不良反应可耐受,治疗过程安全性良好。

Objective:To observe the short-term efficacy and safety of raltitrexed in the treatment of pseudomyxoma peritonei(PMP)by hyperthermic intraperitoneal chemotherapy(HIPEC)after cytoreductive surgery(CRS).Methods:The PMP patients who received CRS combined with HIPEC in our hospital from January 2019 to March 2020 were analyzed retrospectively.They were divided into observation group and control group according to whether or not the postoperative infusion drug scheme was used with raltitrexed.In the observation group,the drug was injected with raltitrexed(4 mg)for the first time and 5-FU(1 g)for the second time to the fifth time after operation.In the control group,5-FU(1 g)was used for 5 times of postoperative perfusion.The general situation,incidence of complications,exhaust time and hospitalization time were compared between the two groups.The changes of blood routine(WBC,PLT),liver function(ALT,AST)and kidney function(Cr)before and after operation were compared between the two groups.Results:A total of 86 patients were treated with CRS and HIPEC during the study period,including 39 patients in the observation group and 47 patients in the control group.The baseline data of the two groups were consistent(P>0.05).There was no significant difference in the incidence of postoperative bleeding,intestinal fistula,pleural effusion and incision infection between the two groups(P>0.05).Chemotherapy-related adverse reactions showed the incidence of abdominal pain in the control group was higher than that in the observation group(P=0.044),and other adverse reactions such as nausea,vomiting,fatigue and fever for more than 3 days had no statistical difference between the two groups(P>0.05).There was no significant difference in hematological examination results between the two groups before and after operation(P>0.05).Conclusion:The application of raltitrexed in HIPEC after CRS for PMP does not increase postoperative complications,and its adverse reactions are tolerable and the treatment process is safe.