丹参及5-氟尿嘧啶胃癌术后早期腹腔化疗的临床应用

Clinical Study on Early Postoperative Intraperitoneal Chemotherapy for Gastric Cancer with Combined Administration of Radix Salviae Miltiorrhizae and 5-Fluorouracil

目的 :探讨丹参联合 5 氟尿嘧啶 (5 FU)对胃癌切除术后早期腹腔化疗 (EPIC)的可行性及近期疗效。 方法 :136例胃癌术后病人分为EPIC、早期静脉化疗 (EPVC)、对照 3组。EPIC组胃癌切除术后 2～ 3d丹参、5 FU腹腔注射 ;EPVC组胃癌切除术后 2～ 3d丹参、5 FU静脉注射 ;对照组术后早期不用任何方式化疗 ,术后 3周常规化疗。分别观察 :(1)EPIC组和EPVC组消化道反应、骨髓抑制和肝肾功能损害等毒副反应 ;(2 )EPIC组和对照组及EPVC组术后切口感染或裂开、吻合口瘘、腹腔脓肿或出血、化学性腹膜炎和粘连性肠梗阻等并发症发生 ;(3) 3组术后近期生存率及腹腔复发率。 结果 :(1)和EPVC组比较 ,EPIC组消化道反应、骨髓抑制和肝肾功能损害等毒副反应明显降低 (P <0 0 5 ) ;(2 )和对照组及EPVC组比较 ,EPIC组切口感染或裂开、吻合口瘘、腹腔脓肿或出血、化学性腹膜炎和粘连性肠梗阻等各项并发症无明显增加 (P >0 0 5 ) ;(3)EPIC组 1年、2年生存率明显高于另外两组 (P <0 0 1) ,而术后 2年腹腔复发率明显低于另两组 (P <0 0 5 )。 结论 :丹参联合 5 FU胃癌术后早期腹腔化疗不仅是安全可行的 ,而且较静脉化疗毒副反应小 ,腹腔复发率低 ,近期生存率满意 ,有较大治疗上的优势。

Objective:To evaluate the safety,feasibility and short-term efficacy of early postoperative intraperitoneal chemothe-rapy(EPIC)with combined administration of radix salviae miltiorrhizae(RSM)and 5-Fluorouracil(5-FU)in treating patients with gastric cancer Methods:136 postoperative gastric cancer patients were divided into 3 groups:EPIC group,early postoperative intravenous chemotherapy group(EPVC group),and control group,EPIC group were treated with RSM and 5-FU injected into the peritoneal cavity on the second or third postoperative day,EPVC group were treated with 5-FU intravenously on the second or third postoperative day,and the control group was treated without any adjuvant chemotherapy in the early postoperative period.Toxicity and adverse reactions such as digestive symptoms,hernopoietic inhibition,liver and kidney dysfunction in EPIC group and EPVC group wrer observed respectively.Postoperative complications such as incision infection,peritonitis,intestinal adhesion and obstruction in EPIC group and control group were observed respectively.Short-term survival rate and intra-abdominal recurrence rate of all patients in the three groups were followed-up.Results:(1)Major adverse effects such as nausea,vomiting,inhibition of bone marrow,liver dysfunction and renal impairment in EPIC group were significantly lower than those in EPIV group( P <0.05-0.01).(2)Serious colplications of infection or dehiscence of abdominal incisions,anastomotic leak,intra-abdominal sepsis,bleeding,chemical peritonitis and bowel obstruction from adhesions attributable to EPIC did not rise as compared with those in control group and EPVC group( P >0.05).(3)Overall survival rate for 1-year and 2-year in EPIC group increased significantly compared with those in the control and EPVC group( P <0.01),and postoperative intra-abdominal recurrence rate in EPIC group decreased significantly compared with those in the control and EPVC group( P <0.05). Conclusion:Administration of EPIC with RSM and 5-FU in patients with gastric cancer is safe and feasible,and compared with EPVC,there are mild toxic and side effects.In addition,a beneficial effect of EPIC has been demonstrated.