结直肠癌术后腹腔热灌注联合全身化疗的疗效观察.docxVIP

结直肠癌术后腹腔热灌注联合全身化疗的疗效观察

【摘要】目的观察结直肠癌术后腹腔热灌注联合全身化疗的疗效及不良反应。方法将我科2000-03-2003-01收治的50例T4病变结直肠癌术后患者采用信封法随机分为腹腔热灌注联合全身化疗的治疗组26例和单纯行全身化疗的对照组24例，观察两组患者腹腔复发率、肝转移率及1年、3年、5年生存率。结果治疗组腹腔复发率及肝转移率明显低于对照组 (23.1%vs50.0%,15.4%vs

41.7%,PV0.05),治疗组1年、3年及5年的生存率明显高于对照组(92.3%vs91.7%,69.2%vs50.0%,38.5%vs20.8%,PV0.05)。两组严重不良反应比较差异无统计学意义(P0.05)。结论本研究提示T4病变结直肠癌术后腹腔热灌注联合全身化疗,能有效降低术后腹腔复发及肝转移，而且提高患者的生存率,不良反应能够耐受。

【关键词】结直肠癌;局部灌注;全身化疗

[Abstract]ObjectiveToobservetheeffectofchemotherapeutichyperthermicintraperitonealperfusioncombinedwithgeneralchemotherapyintreatmentofpostoperativecoloretalcancer.Methods50patientswithT4stagesofcolorectalcarcinomaaftersurgeryfromMar.2000toJan.2003wereenrolled.Usingsealedenvelopemethodand,allpatinetswererandomlydivededintotreatmentgroup(n=26)andcontrolgroup(n=24).Thetreatmentgroupwastreatedwithchemotherapeutichyperthermicintraperitonealperfusioncombinedwithgeneralchemotherapyandthecontrolgroupwastreatedwithgeneralchemotherapyalone.Theincidenceofperitonealrecurrenceandlivermetastasis,and1,3,5yearsurvivalrateofeachgroupwereanalyzed.ResultsTheincidenceofperitonealrecurrenceandlivermetastasisinthetreatmentgroupweresignificantlylowerthanthoseinthecontrolgroup(23.1%vs50.0%,15.4%vs41.7%,PV0.05),the1,3and5year-survivalrateswerealsosignificantlyhigherthanthoseinthecontrolgroup(92.3%vs91.7%,69.2%vs50.0%,38.5%vs20.8%,PV0.05).Therewasnosignificantdifferenceofthemainadversereactionbetweenthetwogroups.Conclusionchemotherapeutichyperthermicintraperitonealperfusioncombinedwithgeneralchemotherapyiseffectiveinreducingincidenceofperitonealrecurrenceandlivermetastasisandincreasingsurvivalrateofcoloretalcancer,withtolerablesideeffect.

【Keywords】Colorectalcarcinoma;Regionalperfusion;Generalchemotherapy

结直肠癌浸润浆膜层后往往发生肉眼或镜下的腹膜播散种植,而结直肠癌的门静脉转移甚至可发生DukesA期，结直肠癌腹膜播散种植和肝转移是术后复发和转移的重要原因，即使采用D4廓清手术都不能清除潜