局部晚期胃癌术后腹腔热灌注联合放化疗的疗效研究
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摘要
目的探讨局部晚期胃癌术后腹腔热灌注联合放化疗的治疗效果。方法选择2013年6月～2015年6月在我院普外三科收治的行手术治疗的60例局部晚期胃癌患者,随机分为实验组25例,行腹腔热灌注化疗联合术后放化疗,对照组35例,仅行术后放化疗,比较两组的临床疗效。结果两组术后肠瘘、肠梗阻发生率比较差异均无统计学意义(P>0.05),实验组术后腹胀、发热发生率均高于对照组,差异均有统计学意义(P<0.05);两组患者治疗前CEA、CA72-4差异无统计学意义(P>0.05),同组患者治疗后CEA、CA72-4水平明显低于治疗前,差异均有统计学意义(P<0.05),实验组治疗后CEA、CA72-4水平低于对照组,其中CA72-4差异有统计学意义(P<0.05);实验组术后局部复发率、病死率低于对照组,差异有统计学意义(P<0.05)。结论腹腔热灌注化疗联合术后放化疗治疗局部晚期胃癌,可以提高临床疗效,降低肿瘤复发率和病死率,有助于延长术后生存时间,改善患者的生活质量。
Objective To investigate the therapeutic effect of intraperitoneal hyperthermic perfusion combined with radiotherapy and chemotherapy in patients with locally advanced gastric cancer. Methods 60 patients with locally advanced gastric cancer who underwent surgical treatment from June 2013 to June 2015 in the Third Department of General Surgery of our hospital, were randomly divided into the experimental group and the control group. 25 patients in the experimental group underwent peritoneal hyperthermic perfusion chemotherapy combined with postoperative radio therapy and chemotherapy. 35 patients in the control group underwent only postoperative radiotherapy and chemotherapy.The clinical effects of the two groups were compared. Results There was no significant difference in the incidence of postoperative intestinal fistula and intestinal obstruction between the two groups(P>0.05). The incidence of postoperative abdominal distension and fever in the experimental group was higher than that in the control group, and the difference was statistically significant(P<0.05). There was no significant difference in CEA and CA72-4 between the two groups before treatment(P>0.05). The levels of CEA and CA72-4 in the same group were significantly lower than those before treatment, and the difference was statistically significant(P<0.05). The levels of CEA and CA72-4 in the experimental group after treatment were lower than those in the control group, and the difference of CA72-4 was statistically significant(P<0.05). The local recurrence rate and mortality rate of the experimental group were lower than those of the control group, with significant difference(P<0.05). Conclusion Intraperitoneal hyperthermic perfusion chemotherapy combined with postoperative radiotherapy and chemotherapy for locally advanced gastric cancer can improve clinical efficacy, reduce tumor recurrence rate and mortality, and help to prolong postoperative survival time and improve patients' quality of life.
Objective To investigate the therapeutic effect of intraperitoneal hyperthermic perfusion combined with radiotherapy and chemotherapy in patients with locally advanced gastric cancer. Methods 60 patients with locally advanced gastric cancer who underwent surgical treatment from June 2013 to June 2015 in the Third Department of General Surgery of our hospital, were randomly divided into the experimental group and the control group. 25 patients in the experimental group underwent peritoneal hyperthermic perfusion chemotherapy combined with postoperative radio therapy and chemotherapy. 35 patients in the control group underwent only postoperative radiotherapy and chemotherapy.The clinical effects of the two groups were compared. Results There was no significant difference in the incidence of postoperative intestinal fistula and intestinal obstruction between the two groups(P>0.05). The incidence of postoperative abdominal distension and fever in the experimental group was higher than that in the control group, and the difference was statistically significant(P<0.05). There was no significant difference in CEA and CA72-4 between the two groups before treatment(P>0.05). The levels of CEA and CA72-4 in the same group were significantly lower than those before treatment, and the difference was statistically significant(P<0.05). The levels of CEA and CA72-4 in the experimental group after treatment were lower than those in the control group, and the difference of CA72-4 was statistically significant(P<0.05). The local recurrence rate and mortality rate of the experimental group were lower than those of the control group, with significant difference(P<0.05). Conclusion Intraperitoneal hyperthermic perfusion chemotherapy combined with postoperative radiotherapy and chemotherapy for locally advanced gastric cancer can improve clinical efficacy, reduce tumor recurrence rate and mortality, and help to prolong postoperative survival time and improve patients' quality of life.
引文
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[11]宋展,钱国武,吕柯,等.局部进展期胃癌术中腹腔热灌注化疗的疗效评价[J].中华普通外科杂志,2015,30(6):425-427.
[12]吴晓江,贾永宁,季加孚.腹腔热灌注化疗在胃癌腹腔转移治疗中的价值[J].中国实用外科杂志,2015,35(10):1071-1075.
[13]Glehen O,Passot G,Villeneuve L,et al.GASTRICHIP:D2 resection and hyperthermic intraperitoneal chemotherapy in locally advanced gastric carcinoma:A randomized and multicenter phaseⅢstudy[J].BMC cancer,2014,14(1):183-189.
[14]Pelz JO,Vetterlein M,Grimmig T,et al.Hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis:Role of heat shock proteins and dissecting effects of hyperthermia[J].Ann Surg Oncol,2013,20(4):1105-1113.
[15]陈新华,罗俊,刘浩,等.腹腔热灌注化疗预防局部进展期胃癌根治术后腹膜复发的研究进展[J].中华胃肠外科杂志,2018,21(5):593-599.
[2]Sato H,Shimada M,Kurita N,et al.Comparison of long term prognosis of laparoscopy assisted gastrectomy and conventional open gastrectomy with special reference to D2 lymph node dissection[J].Surg Endose,2012,26(8):2240-2246.
[3]Dang Y,Wang YC,Huang QJ.Microarray and next-generation sequencing to analyse gastric cancer[J].Asian Pac J Cancer Prev,2014,15(19):8033-8039.
[4]李征,米登海,杨克虎,等.腹腔热灌注化疗治疗癌性腹水的系统评价[J].中国普通外科杂志,2014,23(8):1106-1111.
[5]Stefano R,Luigi B,Francesca R,et al.Locally advanced gastric cancer:A new definition to standardize[J].J Clin Pathol,2013,66:164-165.
[6]季加孚.我国胃癌防治研究三十年回顾[J].中国肿瘤临床,2013,40(22):1346-1351.
[7]吴印兵,巴明臣,崔书中,等.进展期胃癌腹腔热灌注化疗临床疗效与安全性Meta分析[J].中华肿瘤防治杂志,2013,20(21):1686-1690.
[8]Spratt JS,Adcock RA,Muskovin M,et al.Clinical delivery system for intraperitoneal hyperthermic chemotherapy[J].Cancer Res,1980,40(2):256-260.
[9]腹腔热灌注化疗技术临床应用专家协作组.腹腔热灌注化疗技术临床应用专家共识(2016版)[J].中华胃肠外科杂志,2016,19(2):121-125.
[10]Yang XJ,Huang CQ,Suo T,et al.Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer:Final results of a phaseⅢrandomized clinical trial[J].Ann Surg Oncol,2011,18(6):1575-1581.
[11]宋展,钱国武,吕柯,等.局部进展期胃癌术中腹腔热灌注化疗的疗效评价[J].中华普通外科杂志,2015,30(6):425-427.
[12]吴晓江,贾永宁,季加孚.腹腔热灌注化疗在胃癌腹腔转移治疗中的价值[J].中国实用外科杂志,2015,35(10):1071-1075.
[13]Glehen O,Passot G,Villeneuve L,et al.GASTRICHIP:D2 resection and hyperthermic intraperitoneal chemotherapy in locally advanced gastric carcinoma:A randomized and multicenter phaseⅢstudy[J].BMC cancer,2014,14(1):183-189.
[14]Pelz JO,Vetterlein M,Grimmig T,et al.Hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis:Role of heat shock proteins and dissecting effects of hyperthermia[J].Ann Surg Oncol,2013,20(4):1105-1113.
[15]陈新华,罗俊,刘浩,等.腹腔热灌注化疗预防局部进展期胃癌根治术后腹膜复发的研究进展[J].中华胃肠外科杂志,2018,21(5):593-599.