82例进展期胃癌术后腹腔持续温热灌注联合静脉双途径化疗的临床疗效观察

Postoperative intraperitioneal hyperthermic chemoperfusion combined with intravenous chemotherapy for 82 advanced gastric cancer patients

目的 探讨进展期胃癌术后行腹腔持续温热灌注联合静脉的双途径化疗的临床疗效。方法 82例Ⅱ～Ⅳ期胃癌术后患者随机分为治疗组和对照组。治疗组 4 6例 ,腹腔持续温热灌注联合静脉的双途径化疗 3次 ,常规静脉化疗 3次 ;对照组 36例 ,常规静脉化疗 6次。两组化疗均采用LFAP方案 (甲酰四氢叶酸钙 +5 氟脲嘧啶 +吡喃阿霉素或米托蒽醌 +顺铂 ) ,并均于术后 2 1～ 2 8d开始化疗。结果 治疗组 1,3年生存率分别为 97.8% (45 / 4 6 )和 82 .6 % (38/ 4 6 ) ,对照组分别为 94 .4 %(34/ 36 )和 6 1.1% (2 2 / 36 )。两组 1年生存率差异无显著性 (P >0 .0 5 ) ,3年生存率差异有显著性 (P <0 .0 5 )。治疗组和对照组Ⅱ度以上胃肠道反应发生率分别为 37.0 %和 80 .6 % ,差异有显著性 (P <0 .0 1) ;两组骨髓抑制差异无显著性 (P >0 .0 5 )。结论 双途径化疗可延长Ⅱ～Ⅳ期胃癌术后患者的生存期 ,降低Ⅱ度以上胃肠道反应发生率。

Objective To evaluate the efficacy of postoperative intraperitoneal hyperthermic chemoperfusion (IHCP) combined with intravenous chemotherapy for advanced gastric cancer. Methods Eighty-two patients with stageⅡ～Ⅳ gastric cancer were postoperatively randomized into two groups;46 patients in treatment group who received IHCP combined with intravenous chemotherapy for three times and 36 patients in control group who received intravenous chemotherapy only for six times. All patients in the two groups received the same chemo-regimen LFAP (CF+5-Fu+THP or MIT+PDD) 21～28 days after operation. Results The 1- year survival rate was 98%(45/46) in the treatment group and 94%(34/36) in the control group without any significant difference (P>0.05). The 3- year survival rate was 83%(38/46) in the treatment group and 61%(22/36) in the control group with significant difference (P<0.05). Gastrointestinal reaction in the treatment group was significantly decreased compared with in the control group (37% vs 80%,P<0.01),whereas no statistically significant difference was noted in bone marrow suppression(P>0.05). Conclusion Intraperitoneal hyperthermic chemoperfusion combined with intravenous chemotherapy can prolong survival and reduce gastrointestinal side-effect which provides an effective treatment option for advanced gastric cancer.