进展期结直肠癌术后腹腔低渗热灌注化疗的安全性和有效性随机对照研究  

Safety and effectiveness analysis of hyperthermic intraperitoneal perfusion chemotherapy combined with venous chemotherapy for advanced colorectal cancer

作　　者：周军[1] 韩渊[2] 孙国辉[2] 宋牧[2] 

机构地区：[1]中山大学孙逸仙纪念医院胃肠外科,广州510288 [2]新疆医科大学第二附属医院肿瘤外科,新疆乌鲁木齐830063

出　　处：《岭南现代临床外科》2016年第3期270-274,共5页Lingnan Modern Clinics in Surgery

基　　金：广东省中医药管理局课题(20151175)

摘　　要：目的评估进展期结直肠癌根治术后早期腹腔低渗热灌注联合静脉化疗（HIPEC）的安全性和有效性。方法 65例进展期结直肠癌患者随机分为（HIPEC联合静脉化疗组（研究组,n=30）及单纯静脉化疗组（对照组,n=35）。根治性切除术后,研究组行HIPEC并FOLFOX6方案静脉化疗。对照组则行单纯FOLFOX6化疗方案静脉化疗,对其临床效果与预后进行比较。结果研究组KPS评分升高率53.33%,对照组升高率40.00%,两组KPS升高率比较有统计学差异（P〈0.05）。两组不良反应,均为可逆性,停药后好转。研究组术后3 d以内的低蛋白血症发生率为20.0%,高于对照组但差异无统计学意义（P=0.17）;术后并发症总发生率也无明显增加,两组均无发生严重并发症。研究组腹腔局部复发率（χ^2=18.056,χ^2=10.187,所有P〈0.05）和肝转移率（14.29%VS 34.38%）较对照组差异有统计学意义,（HIPEC联合静脉化疗组的复发和肝转移率呈下降改变。研究组术后1年、3年、5年生存率分别为97.3%、71.8%、50.9%;对照组分别为96.7%、60.3%、39.2%,两组术后1年生存率比较,差异无统计学意义（P〉0.05）,而两组术后3、5年生存率比较,差异有统计学意义（P〈0.05）。结论进展期结直肠癌根治术后（HIPEC联合静脉化疗安全有效,患者3、5年生存率和生活质量获益,是分期较晚的结直肠癌较为有效的辅助治疗方式。Objective To evaluate the clinic effects of hyperthermic intraperitoneal perfusion chemotherapy （HIPEC） combined with venous chemotherapy for the treatment of advanced colorectal cancer. Methods Sixty-five cases of advanced coloreetal cancer were divided into HIPEC group （n= 30）and control group （n=35）. After radical resection, HIPEC were combined the FOLFOX6 chemotherapy plan in experiment group. Whereas the control group were received FOLFOX6 chemotherapy plan only. The clinical effect and prognosis were compared. Results The KPS scale increasing rate were 53.33% in HIPEC group and 40.00% in control group respectively. The variation between the two groups achieved statistical significance （P〈0.05）. Two adverse reactions are reversible, and became better after discontinuation. The incidence rate of hypoproteinemia were 20.0% at the third day after operation. There were no severe complications occurred in two groups. And there were no significant increase about the incidence rate of overall postoperative complications. The local recurrence and liver metastasis rate of HIPEC group were significantly lower than the control group,the difference was statistically significant （χ2=18.056, χ2=10.187, all P values were less than 0.05）. The 1-, 3-, and 5-year survival rates in treatment group were 97.3%, 71.8%, 50.9% and 96.7%, 60.3%, 39.2% in control group respectively. The 1-year survival rate achieved no statistical significance （P〉0.05）, but the 3- and 5-year survival rates achieved statistical significance between the two groups （all P values were less than 0.05）. Conclusion When combined with venous chemotherapy, （HIPEC was safe, reliable.It can improve the quality of life and raise the 3- and 5-year survival rate of the advanced colorectal cancer patients significantly. It was effective adjuvant treatment to colorectal cancer.

关 键 词：进展期结直肠癌 腹腔灌注 温热低渗液化疗 生存率 

分 类 号：R656.9[医药卫生—外科学]