60例进展期胃癌术中腹腔热灌注化疗的临床观察

詹宏杰; 梁 寒; 王宝贵; 邓靖宇; 郝希山

doi:10.3969/j.issn.1000-8179.2010.04.015

60例进展期胃癌术中腹腔热灌注化疗的临床观察

Efficacy of Intraoperative Hyperthermic Peritoneal Perfusion on 60Patients with Advanced Gastric Carcinoma

摘要

摘要: 目的：探讨术中腹腔热灌注化疗（CHPP）对进展期胃癌的疗效。方法：将60例进展期胃癌患者随机分为两组，常规行D2 根治术，根据术中是否应用腹腔热灌注化疗，随机分为腹腔热灌注化疗组（治疗组）和单纯手术组（对照组），两组术后4 周均予以FOLFOX 4 方案静脉全身化疗12个疗程。测定患者手术前后外周血中CEA 和CA19-9 含量的变化，观察并比较患者术后生存和肿瘤复发情况。结果：两组60例胃癌患者术前外周血CEA 、CA19-9 均值高于正常参考值上限（55.89± 22.25μ g/L vs 0～5 μ g/L；125.35± 61.78U/mL vs0～39U/mL，P<0.01）；且术前治疗组与对照组外周血CEA 、CA19-9 均值的差异无统计学意义（54.67± 22.95μ g/L vs 56.09± 22.15μ g/L；126.16± 62.45U/mL vs123.35± 60.88U/mL，P>0.05）。术后第7 天，治疗组患者血清CEA 、CA19-9 下降显著（7.58± 3.21μ g/L，31.35± 13.47U/mL，P<0.01），对照组患者术后血清CEA 和CA19-9 下降缓慢（37.68± 20.59μ g/L，98.23± 36.28U/mL，P>0.05）。术后第30天，两组患者的血清CEA 、CA19-9 均较术前有显著性差异（P<0.05）。治疗组与对照组术后1 年生存率分别为83.3% 和80.0% ，两组差异无统计学意义（P>0.05），3 年生存率分别为63.3% 和40.0% ，差异有统计学意义（P<0.05）；治疗组与对照组术后1 年肿瘤复发率分别为8.9% 和12.1% ，两组差异无统计学意义（P>0.05），3 年复发率分别为21.6% 和43.5% ，两组差异有统计学意义（P<0.05）。结论：手术联合 CHPP能够显著降低进展期胃癌患者的外周血CEA 和CA19-9 的含量，术中 CHPP有利于降低复发率和提高生存率。

Abstract: Objective:To evaluate the efficacy of intraoperative hyperthermic peritoneal perfusion (CHPP) on advanced gastric carcinoma. Methods:Sixty patients with advanced gastric carcinoma were divided into the control group and the treatment group. All patients underwent radical gastrectomy and D2 node dissection. Patients in the treatment group received CHPP when surgical resection was completed. Patients in the control group underwent resection of gastric carcinoma without CHPP. Chemotherapy was administered with FOLFOX 4 regimen intravenously for 12 cycles in both groups at 4 weeks after surgery. The serum Carcinoembryonic antigen (CEA) and CA 19-9 were measured in patients with advanced gastric cancer before and after resection of tumor. Survival and recurrence in both groups were analyzed and compared. Results: The mean levels of the expression of CEA and CA 19-9 in the peripheral blood of the 60patients were significantly higher than the upper limits of normal (55.89± 22.25μ g/L vs 0~5 μ g/L; l25.35± 61.78U/mL vs 0~39U/mL P<0.01). There were no significant differences in the mean levels of the expression of CEA and CA 19-9 in the peripheral blood between the treatment group and the control group (54.67± 22.95μ g/L vs 56.09± 22.15μ g/L; 126 .16± 62.45U/mL vs 123 .35± 60.88U/mL, P>0.05). The serum CEA and CA 19-9 levels were significantly decreased at 7 days after treatment in the treatment group ( 7.58± 3.21μ g/L, 31.35± 13.47U/mL, P<0.01). The levels of these two tumor markers were decreased unremarkably at 7 days after treatment in the control group (37. 68± 20.59μ g/L, 98.23± 36.28U/mL, P>0.05). The serum CEA and CA 19-9 levels were decreased significantly in both groups at 30days after surgery ( P<0.05). One-year survival and recurrence rates were 83.3% and10% in the treatment group and 80% and13.3% in the control group, with no significant differences between the two groups (P> 0.05). Three-year survival and recurrence rates were 63.3% and 20% in the treatment group and 40% and 40% in the control group, with a significant difference between the two groups (P<0.05). Conclusion:Surgical resection combined with CHPP can significantly decrease the serum CEA and CA 19-9 levels. Intraoperative CHPP for patients with advanced gastric carcinoma is helpful for preventing peritoneal metastasis and recurrence and can prolong survival time.

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