结直肠癌根治术中采用氟尿嘧啶与洛铂腹腔化疗的疗效及安全性对比

Comparative effectiveness research of the effect and safety of intraperitoneal chemotherapy with fluorouracil and lobaplatin during radical resection of colorectal cancer

目的 比较结直肠癌根治术中采用氟尿嘧啶与洛铂腹腔化疗的疗效及安全性。方法 回顾性选取安徽医科大学第一附属医院2014年3月—2017年9月收治的结直肠癌患者68例作为研究对象,患者均行R0根治性切除术,根据术中腹腔化疗药物不同分为洛铂组30例和氟尿嘧啶组38例。术中洛铂组予以注射用洛铂进行腹腔化疗,氟尿嘧啶组予以氟尿嘧啶植入剂于术野内多点放置,2组患者均于术后1个月接受标准XELOX辅助化疗方案。比较2组术后3 d及辅助化疗前的血常规[白细胞计数(WBC)、血小板计数(PLT)]、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)]、肾功能指标[血肌酐(SCr)、血尿素氮(BUN)]、术后恢复情况、不良反应发生情况、术后不良事件发生情况及术后1、3、5年肿瘤复发/转移发生率,并绘制K-M生存曲线比较2组5年无病累积生存率。结果 术后3 d 2组血常规、肝肾功能指标及辅助化疗前WBC、PLT、ALT、AST、SCr比较,差异无统计学意义(P>0.05);但氟尿嘧啶组辅助化疗前BUN低于洛铂组(P<0.01)。2组术后住院时间、引流管留置时间、禁食水时间、术后开放流质饮食时间及术后热峰情况比较,差异无统计学意义(P>0.05)。2组消化道反应发生率比较,差异无统计学意义(P>0.05);氟尿嘧啶组术后不良事件总发生率低于洛铂组(P<0.01)。2组术后1、3、5年肿瘤复发/转移发生率及术后5年无病累积生存率比较,差异无统计学意义(P>0.05)。结论 结直肠癌根治术中采用洛铂与氟尿嘧啶腹腔化疗在对机体血液毒性、肝肾功能、术后恢复、术后肿瘤复发/转移率及5年无病累积生存率、不良反应的影响上无明显差异,但相较于洛铂,缓释氟尿嘧啶在降低术后不良事件发生率上更占优势。

Objective To compare the effect and safety of intraperitoneal chemotherapy with fluorouracil and lobaplatin during radical resection of colorectal cancer.Methods A total of 68 cases of colorectal cancer patients were retrospectively selected from March 2014 to September 2017 in the First Affiliated Hospital of Anhui Medical University,all patients were treated with R0 radical resection surgery,and the patients were divided into the lobaplatin group with 30 cases and the fluorouracil group with 38 cases according to intraoperative chemotherapy drugs.During operation,the lobaplatin group was given intraperitoneal chemotherapy with lobaplatin for injection,and the fluorouracil group was given fluorouracil implants placed at multiple points in the operating field,and patients were received standard XELOX chemotherapy regimen 1 month after operation.Routine blood testes(WBC,PLT),liver function indexes(ALT,AST),renal function indexes(SCr,BUN)at 3 days after operation and before adjuvant chemotherapy,postoperative recovery,incidence of adverse reactions,incidence of adverse events,incidence of tumor recurrence/metastasis at 1,3,5 years after operation were compared between the two groups,K-M survival curve was drawn to compare the 5-year disease-free cumulative survival rate between the two groups.Results There was no significant difference in routine blood testes,liver function indexes,renal function indexes at 3 days after operation and WBC,PLT,ALT,AST,SCr before adjuvant chemotherap(P>0.05);but BUN before adjuvant chemotherap of the fluorouracil group was lower than that of the lobaplatin group(P<0.01).There was no significant difference of the postoperative hospitalization time,indwelling time of drainage tube,fasting time,postoperative open liquid diet time and postoperative hot peak between the two groups(P>0.05).There was no significant difference of the incidence of digestive tract reactions between the two groups(P>0.05);and the incidence of adverse events of the fluorouracil group was lower than that of the lobaplatin group(P<0.01).There was no significant difference of incidence of tumor recurrence/metastasis at 1,3,5 years after operation and 5-year disease-free cumulative survival rate between the two groups(P>0.05).Conclusion There is no significant difference in the effects of intraperitoneal chemotherapy with lobaplatin and fluorouracil on blood toxicity,liver and kidney function,postoperative recovery,postoperative recurrence/metastasis rate,5-year disease-free cumulative survival rate and adverse reactions,but compared with lobaplatin,sustained-release fluorouracil is more dominant in reducing the incidence of postoperative adverse events.