腹腔灌注化疗治疗恶性腹水有效性和安全性的临床对照研究

Effectiveness and Safety of Intraperitoneal Perfusion Chemotherapy for Malignant Ascites: A Controled Clinical Study

目的:观察并比较顺铂(DDP)与氟尿嘧啶(5-FU)联合持续腹腔热灌注化疗、常温腹腔灌注化疗以及全身静脉化疗治疗恶性腹水的有效性及安全性。方法:收集并分析甘肃省第二人民医院和甘肃省武威肿瘤医院自2006年1月至2013年12月期间所收治的因恶性肿瘤所致恶性腹水的51例患者,依据治疗方法不同,将其分为三组:A组(20例,顺铂加氟尿嘧啶联合持续腹腔热灌注化疗),B组(17例,顺铂加氟尿嘧啶联合常温腹腔灌注化疗),C组(14例,顺铂加氟尿嘧啶联合全身静脉化疗),治疗完成后,对三组患者的疗效、腹胀改善情况、腹水变化情况、癌细胞涂片转阴率、不良反应和毒副作用等进行观察和比较。结果:三组总有效率分别为85.00%(17/20)、52.94%(9/17)、35.71%(5/14);与B、C两组相比,A组患者的腹胀情况明显改善,腹水量明显减少,腹水中癌细胞转阴率明显升高,不良反应和毒副作用轻微。三组患者在治疗过程中均未出现肠粘连和肠梗阻等治疗相关并发症及III或IV级严重的毒副反应。结论:从有效性角度来说,常温腹腔灌注化疗方案优于全身静脉化疗,而持续腹腔热灌注化疗方案优于常温腹腔灌注化疗;此外,与全身静脉化疗相比,腹腔灌注化疗方案(包括常温灌注及热灌注)具有更好的临床安全性。

Objective: Observe and compare the effectiveness and safety among continuous intraperitoneal hyperth ermic perfusion chemotherapy, room temperature intraperitoneal perfusion chemotherapy and systemic chemotherapy, use cisplatin( DDP) combined with fluorouracil( 5-FU), on the treatment of malignant ascites. Methods: Collect 51 patients with malignant ascites admitted by the Second People’s Hospital of Gansu Province and the Wuwei Tumor Hospital from January 2006 to December 2013. These patients were divided into three groups according to different treatment methods: group A( 20, continuous intraperitoneal hyperthermic perfusion chemotherapy),group B( 17, room temperature intraperitoneal perfusion chemotherapy), group C( 14, systemic chemotherapy). Then observe and compare the effectiveness, abdominal distension, the depth of ascites, cancer cell smear negative rate, adverse reactions and side effects of the three groups. Results:The total effectiveness of the three groups respectively are 85.00%( 17/20), 52.94%( 9/17), and 35.71%( 5/14).Compared with the B and C groups, the efficacy of group A is significant, and the side effects are mild. Conclusions:From the effectiveness perspective, room temperature intraperitoneal perfusion chemotherapy is better than systemic chemotherapy, and continuous intraperitoneal hyperthermic perfusion chemotherapy is better than room temperature intraperitoneal perfusion chemotherapy; In addition,compared with systemic chemotherapy, intraperitoneal perfusion chemotherapy( including hyperthermic and room temperature intraperitoneal perfusion chemotherapy) has better clinical safety.