Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

BACKGROUND Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL. AIM To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms. METHODS This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis. RESULTS The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group (P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation (P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386;95%CI: 1.808-16.042;P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer. CONCLUSION Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

洛铂应用于结直肠癌术中腹腔灌注化疗的近期临床疗效分析

目的探讨在结直肠癌手术过程中使用洛铂进行腹腔灌注化疗的近期临床疗效。方法选取2021年9月至2022年12月在右江民族医学院附属医院胃肠外科住院手术治疗的结直肠肿瘤患者共80例,随机分成两组,观察组与对照组各40例,术中行腹腔灌注化疗组为观察组,常规手术组为对照组。观察患者肠道功能恢复情况、术后并发症情况、化学药物治疗的毒副作用以及免疫功能,并对两组患者进行随访,记录患者术后6个月和术后12个月的复发与转移发生率。结果对两组患者的一般资料、肠道功能恢复、术后并发症、化学药物治疗的毒副作用以及免疫功能进行比较,结果差异无统计学意义(P>0.05);对比分析两组患者的术后12个月的复发与转移情况,观察组结果均优于对照组,差异有统计学意义(P<0.05)。结论在结直肠癌手术中使用洛铂进行腹腔灌注化疗,不损害患者免疫功能和胃肠道功能,同时不增加手术并发症,可以降低患者的近期复发率,是安全而有效的,临床疗效良好,是一种有效的辅助治疗方式。

Sustained co-delivery of 5-fluorouracil and cis-platinum via biodegradable thermo-sensitive hydrogel for intraoperative synergistic combination chemotherapy of gastric cancer

Gastric cancer is the fifth most common cancer and the third leading cause of cancer death worldwide,posing a severe threat to human health.Surgical resection remains the most preferred option for gastric cancer treatment.However,for advanced gastric cancer,the curative effect of surgical resection is usually limited by the local recurrence,peritoneal carcinomatosis,or distal metastasis.Intraoperative chemotherapy is an attractive in situ adjuvant treatment strategy to reduce the recurrence and metastasis after surgical resection.Here,we designed a 5-fluorouracil(5-FU)and cis-platinum(DDP)co-delivery system based on a biodegradable temperature-sensitive hydrogel(PDLLA-PEG-PDLLA,PLEL)for intraoperative adjuvant combination chemotherapy of gastric cancer.This 5-FU+DDP/PLEL hydrogel system characterized by a special sol-gel phase transition in response to physiological temperature and presented sustained drug release in vitro and in vivo.A strong synergistic cell proliferation inhibition and apoptosis promotion of 5-FU+DDP/PLEL were observed against gastric cancer MKN45-luc cells.After intraperitoneal injection,the dual-drug loaded hydrogel formulation showed superior anti-tumor effects than the single-drug carrying hydrogels and combination of free 5-FU and DDP on the gastric cancer peritoneal carcinomatosis model.The use of hydrogel for dual-drug delivery had benefited to fewer side effects as well.What’s more,we established a mouse model for postsurgical residual tumors and peritoneal carcinomatosis of gastric cancer,in which the intraoperative administration of 5-FU+DDP/PLEL also remarkably inhibited the local recurrence of the orthotopic tumors and the growth of the abdominal metastatic tumors,resulting in an extended lifetime.Hence,this developed dual-drug loaded hydrogel system has great potential in the intraoperative chemotherapy of gastric cancer,that suggests a clinically-relevant and valuable option for postsurgical management of gastric cancer.

Adjuvant Chemotherapy May Not Be Necessary for Women with Stage IC1 Epithelial Ovarian Cancer

Objective:To determine whether adjuvant chemotherapy improves the prognoses in women with stage IC1 epithelial ovarian cancer(EOC).Methods:All eligible women diagnosed with stage IC1 EOC from 2003 to 2019 in Tongji Hospital were included.Patient characteristics,tumor features,surgical types,and chemotherapeutic treatments were collected.Kaplan-Meier analysis and Cox regression analysis were performed to evaluate progression-free survival(PFS)and overall survival(OS).

Experience after 100 patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

AIM:To investigate perioperative patient morbidity/mortality and outcome after cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS:Of 150 patients 100 were treated with cytoreductive surgery and HIPEC and retrospectively analyzed.Clinical and postoperative follow-up data were evaluated.Body mass index(BMI),age and peritoneal carcinomatosis index(PCI) were chosen as selection criteria with regard to tumor-free survival and perioperative morbidity for this multimodal therapy.RESULTS:CRS with HIPEC was successfully performed in 100 out of 150 patients.Fifty patients were excluded because of intraoperative contraindication.Median PCI was 17(1-39).In 89% a radical resection(CC0/CC1) was achieved.One patient died postoperatively due to multiorgan failure.Neither PCI,age nor BMI was a risk factor for postoperative complications/outcome according to the DINDO classification.In 9% Re-CRS with HIPEC was performed during the follow-up period.CONCLUSION:Patient selection remains the most important issue.Neither PCI,age nor BMI alone should be an exclusion criterion for this multimodal therapy.

Advanced ovarian cancer: Neoadjuvant chemotherapy plus surgery and HIPEC as up-front treatment

Epithelial ovarian cancer(EOC) is one of the most common malignancies and one of the principal causes of death in gynecological neoplasms. The majority of EOC patients present with an advanced International Federation of Gynecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy of a platinum agent and paclitaxel. Even if the majority of patients with EOC respond to first-line platinum based chemotherapy, almost 20% of them are resistant or refractory. According to these data, the main risk is for a certain number of patients to have undergone cytoreductive surgery(CRS) and subsequent hyperthermic intraoperative peritoneal chemotherapy(HIPEC) in a useful way. Radical surgery, especially in advanced cases, is associated with a high incidence of postoperative morbidity and mortality, which could be increased by the HIPEC. Every effort should be made for previously selected patients to improve outcome and optimize resources. Over the last decade, new options have been introduced to prolong survival. Improved long-term results can be achieved using CRS in combination with intraoperative HIPEC. This combination has also been used in an up-front setting. Controversial outcomes have been reported for neoadjuvant platinum-based chemotherapy. Different papers have been published reporting discordant results. Further studies are needed.

紫杉醇联合顺铂循环式腹腔热灌注化疗对卵巢癌疗效和安全性分析

目的探讨紫杉醇联合顺铂循环式腹腔热灌注化疗对卵巢癌的疗效与安全性。方法回顾性分析我院2011年8月至2013年8月期间收治的96例中晚期卵巢癌患者,根据两种不同治疗方法分为观察组与对照组,每组48例。对照组采用卵巢癌细胞减灭术后予紫杉醇联合铂类全身静脉化疗治疗,观察组采用手术结合紫杉醇联合顺铂循环式腹腔热灌注化疗术,术后予TP方案静脉化疗,对两组患者治疗效果及安全性进行比较。结果观察组治疗有效率为87.50%,对照组治疗有效率为60.42%,两组差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论卵巢癌细胞减灭术后紫杉醇联合顺铂腹腔热灌注化疗辅助静脉化疗对于中晚期卵巢癌患者具有积极的治疗作用,能够有效控制肿瘤进展及恶性腹水,延长患者无进展生存期,提高患者生活质量,且不良反应可耐受。

胃癌术中动脉区域灌注化疗与全身静脉化疗的临床疗效比较

目的 评价胃癌术中动脉区域灌注化疗药物的临床疗效。方法 对 40例经病理确诊的胃癌患者 (治疗组 )于术中经供应肿瘤的区域动脉行插管化疗 ,同时进行手术治疗 ,并与同期术中行全身静脉化疗的 2 4例胃癌患者 (对照组 )进行临床疗效比较。结果 术后病理检查显示 ,治疗组原发灶中的癌细胞均有不同程度地变性坏死 ,其近期有效率为 95 % ,对照组有效率为 41.6 7% ,两组比较差异显著 (P<0 .0 5 )。结论 胃癌患者术中经动脉灌注化疗 ,其近期抗癌效果好 ,毒副反应轻 ,对减少或防止术中癌细胞的医源性扩散与种植以及术后复发 。

细胞减灭术加腹腔热灌注化疗治疗腹膜种植瘤的研究进展

腹盆腔肿瘤局部进展所导致的腹膜种植瘤是致命性病变,传统治疗方法的效果非常有限,国际上近年来把细胞减灭术加腹腔热灌注化疗作为新治疗模式,作者分析这方面的研究进展。文献检索分析腹膜种植瘤的发病率,病理生理学基础,药物治疗学基础,介绍细胞减灭术加腹腔热灌注化疗治疗各类腹膜种植瘤的临床试验结果。胃癌、结直肠癌、卵巢癌、腹膜间皮瘤、腹膜假黏液瘤、腹腔肉瘤都可形成腹膜种植瘤,常规化疗的中位生存期约6个月。术中腹腔内热灌注化疗可使腹腔内药物浓度比血液内高10～1000倍,温热与化疗有协同抗肿瘤作用。腹膜种植瘤指数是判断癌症腹膜播散程度的客观标准,最大程度细胞减灭术加腹腔内热灌注化疗能显著延长病人的中位生存期:结直肠癌可达到20个月,胃癌达10个月,卵巢癌达65个月,围手术期病残率约27～56%、死亡率0～11%。大多数为Ⅱ期临床研究,Ⅲ期随机分组临床试验较少。细胞减灭术加腹腔热灌注化疗是目前治疗腹膜种植瘤的最有效方法,需要前瞻性多中心随机分组临床试验,以进一步优化技术,提高疗效。

胃肠道癌术中腹腔内温热化疗临床适应证的探讨

目的:探讨胃肠道癌术中腹腔内温热化疗(IPHC)防治腹膜转移的临床适应证.方法:78例胃癌,5例结肠癌,剖腹后先收集腹水或腹腔冲洗液行细胞学或病理学检查,寻找游离癌细胞,并与肿瘤生物学特性进行单因素和多因素判别分析.结果:腹腔内游离癌细胞阳性率同腹膜转移、浆膜侵犯、TNM分期、浆膜侵犯面积、淋巴转移、腹水、Borrmann分型等因素有关(P<0.05),其中前两者为独立影响因素(P<0.0001).结论:IPHC的临床适应证为:①肉眼可见腹膜转移灶或癌性腹水;②术后腹膜转移;③腹腔冲洗液中发现游离癌细胞;④肿瘤侵及浆膜.

术中腹腔灌注热化疗治疗进展期胃肠道肿瘤的安全性研究

目的探讨胃肠道肿瘤患者行术中腹腔热灌注化疗(intraoperative peritoneal hyperthermia chemotherapy,IPHC)的安全性。方法采用新型热化疗仪术中灌注蒸馏水、奥沙利铂和5-Fu,监测75例(IPHC组)T3、T4期胃肠道肿瘤患者术中鼻咽部温度、循环生理及氧饱和度变化;并与同期施行的56例(对照组)T3、T4期胃肠道肿瘤患者对比血常规、肝肾功能主要指标及术后并发症发生率。结果 IPHC组患者术中鼻咽部温度升高,术后很快恢复,均在安全范围内;心率变化与鼻咽部温度变化基本同步,平均动脉压(MVP)下降,中心静脉压(CVP)先升高,再下降;术后血淋巴细胞计数、BUN值较对照组高(P<0.05),但BUN在术后3个月内恢复正常;伤口感染及腹腔感染发生率较对照组低(P<0.05)。结论进展期胃肠道肿瘤行术中IPHC会对患者循环生理和肾功能造成一定影响,但均在可控范围内,如加强监护,IPHC法安全可行。

胃癌根治术中腹腔内温热化疗的临床安全性研究

目的:探讨胃癌根治术中腹腔内温热化疗(IPHC)的临床安全性。方法:监测49例接受IPHC治疗的进展期胃癌病人术中体温及呼吸、循环生理指标的变化;比较IPHC组病人(49例)与对照组病人(79例)手术死亡率和并发症发生率的差异。结果:IPHC过程中,病人的血温和颅温均显著上升,但未达到危险程度;同时肺顺应性下降、气道压力升高,但术后均顺利恢复正常;呼气末二氧化碳持续升高并保持在较高水平;心率、心排指数(CI)逐渐上升,但每搏指数(SVI)并无变化;外周阻力指数(SVRI)显著下降,而平均动脉压(MAP)、中心静脉压(CVP)、肺动脉楔压(PAWP)及平均肺动脉压(MPAP)均先行上升,然后逐渐下降,术后恢复正常。IPHC组与对照组的手术死亡率无显著差异;IPHC组和对照组的并发症发生率分别为18.4%和11.4%,无显著差异;IPHC组的肾功能异常发生率为14.3%,显著高于对照组的3.8%(P<0.05);吻合口漏发生率两组间无显著差异。结论:IPHC虽对人体生理造成一定影响,但均在可控制范围之内;其临床应用安全可靠。

肝门胆管癌103例诊治分析

目的:探讨不同方法治疗肝门胆管癌的预后及其影响因素。方法:103例肝门胆管癌患者中行根治性切除28例,姑息性切除12例,经皮经肝胆管引流术(PTCD)+经皮胆道支架植入术34例,仅行PTCD术29例。结果:4种手术患者中位生存期分别为(26.00±1.51)个月、(16.00±1.49)个月、(12.00±1.83)个月和(5.00±1.49)个月,差异有统计学意义(P<0.01);Bismuth分型、有无淋巴结转移及是否术中化疗均影响患者预后。结论:根治性手术切除是肝门胆管癌的最佳治疗方法。Bismuth分型、有无淋巴结转移及是否术中化疗是影响预后的重要因素。

乳腺癌术中植入缓释氟尿嘧啶间质化疗的研究

目的探讨在乳腺癌改良根治术中植入缓释氟尿嘧啶的临床安全性及疗效。方法乳腺癌改良根治术患者187例,其中浸润性导管癌155例,髓样癌24例,原位癌8例;TNM分期Ⅰ-Ⅱ期134例,Ⅲ期53例。按随机数字表法分为植入剂组95例和对照组92例。植入剂组在肿瘤下方、腋窝、锁骨下血管区域、胸大小肌之间多点撒入氟尿嘧啶植入剂,总剂量为600mg。对照组无植入。术后常规化疗。观察术后切口感染、渗液或裂开,患肢水肿、组织溃烂情况及局部疼痛、皮瓣坏死、皮下积液等局部不良反应情况;观察手术前后患者的血红细胞、白细胞计数及谷丙转氨酶、血肌酐水平;观察患者肿瘤局部复发情况和3年生存率。结果植入剂组和对照组均未发生切口感染、渗液或裂开及患肢水肿、组织溃烂情况;局部疼痛、皮下积液、皮瓣坏死发生率植入组分别为8.42%、15.79%、10.53%,对照组分别为6.52%、11.96%、11.96%,2组比较差异无统计学意义(P>0.05)。2组术后全身不良反应比较差异均无统计学意义(均P>0.05)。植入剂组术后局部复发6例(6.3%),对照组术后局部复发15例(16.3%),2组间差异有统计学意义(P=0.031);植入剂组死亡6例(3年生存率为93.7%),对照组死亡16例(3年生存率为82.6%),2组比较差异有统计学意义(P=0.019)。结论乳腺癌改良根治术的患者术中植入缓释氟尿嘧啶是安全、有效的,是乳腺癌术后局部化疗的有效途径,可减少乳腺癌术后局部复发,提高远期生存率。

子宫内膜癌术中区域性动脉灌注化疗的研究

目的:研究子宫内膜癌术中区域性动脉灌注化疗(ILAIC)的药代动力学特点、组织病理学变化以及子宫内膜癌的近期疗效和作用机制。方法:(1)随机将40只新西兰白兔分为动脉灌注组和静脉注射组,用高效液相色谱分析仪(HPLC)测定不同途径注射顺铂(cDDP)后血浆及组织中的药物浓度,比较髂内动脉灌注与耳缘静脉注射cDDP后,其药代动力学参数及子宫、肾脏中药物浓度的差异;(2)用TUNEL法研究ILAIC诱导子宫内膜癌细胞凋亡的情况;免疫组织化学法研究ILAIC对子宫内膜癌细胞PCNA表达的影响。结果:(1)ILAIC后cDDP的代谢符合二室开放模型。动脉组子宫中药物浓度明显高于静脉组,而肾脏药物浓度明显低于静脉组(P<0.05);(2)动脉灌注组中肿瘤细胞的增殖指数(PI)为(44.25±19.89)%,略低于静脉组的(52.00±14.64)%,但差异无显著性(P>0.05);(3)动脉灌注组中肿瘤细胞的凋亡指数(AI)为(16.00±11.54)%,明显高于静脉组的(7.20±6.24)%,差异有显著性(P<0.05)。结论:ILAIC后,子宫中有较高浓度的化疗药物而肾脏中的药物浓度明显低于静脉化疗后;ILAIC对肿瘤细胞的杀伤作用部分是通过诱导细胞凋亡实现的,同时可降低肿瘤细胞的增殖活力;初步结果显示,ILAIC近期疗效可靠,无明显副作用。

脑胶质瘤手术对顺铂通过血-脑脊液屏障的影响

目的观察脑胶质瘤手术创伤对顺铂通过血-脑脊液屏障的影响,探讨术中使用化学药物治疗脑胶质瘤的可行性和安全性。方法 24例行脑胶质瘤切除术患者分为术前给药组和术中给药组,每组12例,术前给药组患者于麻醉开始时静脉泵入顺铂,持续30 min,泵入顺铂结束30 min后打开硬脑膜,取血浆、肿瘤组织、肿瘤周围组织及脑脊液标本;术中给药组患者于切硬脑膜同时静脉泵入顺铂,持续30 min,泵入顺铂结束后30 min、肿瘤全切除前,取血浆、肿瘤组织、肿瘤周围组织及脑脊液标本。应用高效液相色谱法检测标本中顺铂的质量浓度,并在第1个化学治疗周期后进行短期药物毒副作用评价。结果 2组患者血浆和肿瘤组织中顺铂质量浓度比较差异均无统计学意义(P>0.05);术中给药组患者脑脊液和肿瘤周围组织中顺铂质量浓度显著高于术前给药组(P<0.05)。术前给药组和术中给药组患者不良反应发生率分别为33.3%和25.0%,2组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论手术创伤能导致血-脑脊液屏障通透性开放,术中化学治疗能显著增加肿瘤周围组织及脑脊液中的药物浓度。脑胶质瘤患者术中化学治疗具有可行性和安全性。

TPF术前诱导化疗对口腔鳞癌患者术中出血及术后伤口渗出的影响

目的:探讨术前诱导化疗对中晚期口腔鳞癌患者术中出血及术后伤口渗出的影响。方法:比较术前诱导化疗组与非化疗组患者化疗前后血小板、血红蛋白、血白蛋白、术中出血量及术后伤口渗出量变化情况。结果:与非化疗组比较,所有术前诱导化疗患者化疗后外周血血小板数量、术后血红蛋白量及外周血白蛋白量均明显降低,术后前3d伤口渗出总量增加,但对术中出血量无影响。结论:术前诱导化疗对骨髓抑制作用明显增强,并且增加了术后伤口渗出,但对术中出血无影响。

乳腺癌改良根治术中局部应用洛铂的疗效观察

目的评价乳腺癌改良根治术中局部应用洛铂的临床疗效。方法选择早期乳腺癌患者50例,随机分为观察组和对照组各25例,均行乳腺癌改良根治术。术中观察组用溶有50 mg洛铂的生理盐水冲洗并浸泡创面,15 min后吸出冲洗液。皮瓣缝合前,再将50 mg洛铂多点喷洒于瘤床、腋窝淋巴结清扫区及其他可疑残余癌细胞区域。对照组仅用等量生理盐水处理。对药物安全性、近期及远期疗效进行追踪和对比研究。结果两组术后的不良反应包括骨髓抑制(白细胞和血小板计数)、肝肾功能(血肌酐和谷丙转氨酶)、局部疼痛和胃肠道反应(恶心、呕吐和腹泻),以及Ⅰ期愈合时间等方面比较无显著差异(P>0.05)。观察组引流液脱落癌细胞检查阳性率和局部复发率均低于对照组,差异有统计学意义(P<0.05),而远处转移率和2年生存率比较无统计学意义(P>0.05)。结论乳腺癌患者改良根治术中应用洛铂安全有效,可显著降低局部复发,值得临床进一步推广。

进展期胃癌术式选择及术中腹腔化疗探析

阐述晚期胃癌TNMⅣ期,其复发形式多见于腹膜播散性转移和种植,并影响预后之重要因素。即使进行根治术,亦仅称之为非治疗性切除术。进展期胃癌进行广泛淋巴清扫价值始终存在分歧和争议。侵出浆膜之患者其五年治疗率低下。肉眼腹膜种植者,腹腔游离癌细胞近乎100%。伴随侵出面积增大,其治疗率而降低。肿瘤标志物监测诸如TPA,CA724,CA242,CA199以及CEA等,睿智据理规范和启迪术式及术中化疗之实施,选定多元化特异性高的标志物检测,可提高敏感性,皆阳性者则诊断无疑。临床残留癌细胞是客观存在,术中第一时间强烈干预腹腔内置入抗癌药物为最理想。诸如MMC-CH,CDDP,Vp16以及区域性缓释化疗抗肿瘤植入剂Sinofuan等不乏为首选。晚期胃癌循规蹈矩进行D2或D3术式,难以达到期望阈值。D2术式不能提高患者生存率。D1,D2术式术后生存率统计学上分析无明显差异。淋巴清扫仅有助于病理分期确切性,偏倚扩大根治术,善其予后难以期待。

子宫内膜癌术中区域性动脉灌注化疗的疗效观察

目的 探讨术中区域性动脉灌注化疗对子宫内膜癌的治疗效果。方法 回顾性分析我院 2 0 0 0年 1月～ 2 0 0 2年 11月间在我科施行了术中动脉灌注化疗的 2 0例子宫内膜癌患者 (灌注组 ) ,选择同期手术治疗的子宫内膜癌患者 33例为对照 (对照组 ) ,分析两组的复发及死亡情况。结果 灌注组中Ⅰ期 8例 ,Ⅱ期 8例 ,Ⅲ期 4例 ,Ⅳ 0例 ,其中 1例ⅢaG2者于术后 8个月盆腔复发 ,无 1例死亡 ,复发率为 5 0 %。对照组中Ⅰ期 2 5例 ,Ⅱ期 3例 ,Ⅲ期 4例 ,Ⅳ 1例 ,其中 3例复发 ,复发率为 9 1%。复发者分别为ⅠbG2 - 3,ⅠcG3和ⅢcG3,1例为阴道断端复发 ,1例为盆腔复发 ,1例为远处脏器转移 ,其中 2例死亡 ,死亡率为 6 1%。两组的平均随访时间为 15 6± 5 2 (个月 )及 16 8± 7 4 (个月 ) ,差异无显著性 (P >0 0 5 )。结论 术中髂内动脉灌注化疗可降低子宫内膜癌的复发率 ,且操作简单易于掌握 ,既具有术前选择性动脉灌注化疗的优点又可避免其弊端 ,值得临床推广。