细胞减灭术加腹腔热灌注化疗治疗腹膜癌  

Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy for the Treatment of Peritoneal Carcinomatosis

作　　者：杨肖军[1] 杨国樑[1] 李雁[1] 卢玉兰[1] 刘少阳[1] 张京伟[1] 陈良冬[1] 

机构地区：[1]武汉大学中南医院肿瘤科/湖北省肿瘤医学临床研究中心,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2010年第2期192-196,共5页Medical Journal of Wuhan University

基　　金：教育部新世纪优秀人才支持计划(编号:NCET-04-0669);全国优秀博士学位论文作者专项资金资助项目(编号:200464)

摘　　要：目的:分析细胞减灭术加腹腔热灌注化疗治疗腹膜癌的围手术期安全性及初步疗效。方法:对21例发生腹膜癌的腹盆腔恶性肿瘤患者行细胞减灭术加腹腔热灌注化疗,药物为羟基喜素碱(HTPC)20mg、丝裂霉素(MMC)30mg、生理盐水12000ml,温度(43±0.5)℃,时间60-90min。记录术后5d体温及心率变化、局部及全身性感染、胃肠道功能恢复、血液学及肝肾功能指标、切口愈合及拆线时间,生存期和生活质量。结果:入组患者21例,其中胃癌12例,结直肠癌5例,卵巢癌2例,腹膜假性黏液瘤1例,腹膜恶性间皮瘤1例。腹膜癌指数2-33(中位数11);手术时间4-10h(中位数6h);术后5d最高体温38.1℃;2例出现局部/全身性水肿,经对症处理后消失;术后1周内血象未见明显异常;术后第1天出现低蛋白血症者5例,天冬氨酸转氨酶升高者3例,其他指标未见异常。拔胃管时间2-7d;进食时间3-8d;拆线时间8-18d;未出现切口感染、切口裂开、腹盆腔或全身感染。随访期31.5-57个月(中位数41个月),13例死亡,2例带瘤生存,6例无瘤生存。结论:细胞减灭术加腹腔热灌注化疗治疗腹膜癌的围手术期安全性好,未出现明显不良事件,能有限延长生存期,改善生活质量。Objective：To study the perioperative safety and efficacy of cytoreductive surgery （CRS） plus hyperthermic intraperitoneal chemotherapy （HIPEC） for the treatment of peritoneal carcinomatosis （PC）. Methods： Twenty-one patients with PC （including 12 gastric cancer, 5 colorectal cancer, 2 ovarian cancer, 1 pseudomyxoma peritonei and 1 malignant mesothelioma） had been treated with CRS plus HIPEC using hydroxycamptothecin （HTPC） 20 mg and mitomycin （MMC） 30 mg in 12 000 ml of normal saline at （43±0.5） ℃ for 60-90 min. Body temperature and heart rate were recorded for 5 days after operation. Local and systemic infections, gastrointestinal function recovery, hematological, hepatic and renal parameters, wound healing time, survival and quality of life were analyzed. Results： The peritoneal cancinomatosis index was 2-33 （median 11）, the durations of operation were 4-10 hours （median 8 hours）, and the highest temperature during 5 postoperative days was 38.1 ℃. Two patients developed generalized edema, which was disappeared after treatment, and 5 patients developed hypoproteinemia on the first day postoperative. All routine blood tests checked in the first week postoperatively were normal. Time of gastric tube removing was 2-7 days, liquid food intake time was 3-8 days, and time of stitches removal was 8-18 days. There was no infection or disruption of wounds and no intraperitoneal or systemic infections. After a median follow-up time of 41 months （31.5-57 months）, 13 patients died, 2 survived with tumor, and 6 survived free of tumor. Conclusion： CRS plus HIPEC proves to be safe with no serious adverse events; and can prolong the survival and improve the quality of life in patients with PC.

关 键 词：腹膜癌 细胞减灭术 腹腔热灌注化疗 

分 类 号：R730.5[医药卫生—肿瘤]