胃癌术后腹腔灌注维拉帕米联合化疗药物的临床效果研究  

Clinical effect of intraperitoneal perfusion of verapamil and chemotherapeutic drugs on treating patients with gastric cancer after operation

作　　者：杨国红 樊高飞[2] 吴旸[2] 刘亚贝[2] 黄金[2] 范平生[1,2] YANG Guohong;FAN Gaofei;WU Yang;LIU Yabei;HUANG Jin;FAN Pingsheng(Medical College of Shandong University,Jinan,Shangdong,250012;Anhui Provincial Cancer Hospital,Hefei,Anhui,230031)

机构地区：[1]山东大学医学院,山东济南250012 [2]安徽省肿瘤医院,安徽合肥230001

出　　处：《实用临床医药杂志》2018年第3期1-8,共8页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金(81350005);安徽省科技厅2012年度重点科研计划项目(12070403058);安徽省自然科学基金(1408085MH211)

摘　　要：目的探讨胃癌根治术后患者腹腔灌注维拉帕米联合化疗药物的疗效及副作用。方法选取接受胃癌根治手术、术后分期为pT_(1/2/3/4)N_(2/3)M_0的184例患者,随机分为对照组58例和治疗组126例。对照组腹腔灌注药物为5-氟尿嘧啶1 g+顺铂70~90 mg,治疗组腹腔灌注药物为5-氟尿嘧啶1.0 g+顺铂70~90 mg+维拉帕米25 mg。2组静脉均使用多柔比星20~30 mg后3~5 h进行腹腔灌注化疗,灌注前30 min静脉使用亚叶酸钙0.1 g。第2天开始静脉使用亚叶酸钙0.1 g、5-氟尿嘧啶0.5~0.75 g共3~5 d。观察12月、24月无病生存率、总生存率和无病生存期(DFS)、总生存期(OS)、腹腔复发率、肝脏转移率、残胃复发率、毒副作用。结果治疗组的12月、24月无病生存率和总生存率均较对照组显著较高,中位DFS、OS较对照组显著延长(P<0.05);区域淋巴结分期(N_2、N_3)、低分化腺癌、原发肿瘤直径≥4 cm的患者12个月、24个月的无病生存率、总生存率较对照组显著提高,中位DFS、OS较对照组显著延长(P<0.05)。治疗组的12月、24月腹腔内复发率、肝脏转移率均较对照组显著降低(P<0.05);治疗组的残胃复发率与对照组比较无显著差异,维拉帕米使用前后未增加化疗药物、心血管系统毒副作用发生率。其中8例患者出现轻度腹痛,3例患者出现不全性肠梗阻,对症处理后1周内好转。结论腹腔灌注维拉帕米联合化疗药物提高了胃癌术后患者12月、24月的无病生存率、总生存率,延长了中位DFS、OS,降低了腹腔内复发率、肝脏转移率。Objective To explore the clinical efficacy and side effects of intraperitoneal perfusion of verapamil and chemotherapeutic drugs in treating patients with gastric cancer after operation.Methods Totally 184 gastric cancer patients accepted radical surgery with postoperative classification(pT 1/2/3/4 N 2/3 M 0)were randomly divided into control group(n=58)and treatment group(n=126).For the post-gastrectomy chemotherapeuric treatment,1g of 5-fluorouracil and 70 to 90 mg of cisplatin were administrated for the patients in the control group,while 1g of 5-fluorouracil,70 to 90 mg of cisplatin and 25 mg of verapamil were given to the patients in the treatment group.Patients in both groups received intravenous administration of 20 to 30 mg of doxorubicin 3~5 hours before the intraperitoneal chemotherapy,and 0.1 g of leucovorin 30 minutes prior to the intraperitoneal chemotherapy.On the second day,intraperitoneal chemotherapy of 0.5 to 0.75 g 5-fluorouracil was given to all patients for 3 to 5 days.The disease-free survival rate,overall survival rate,disease-free survival(DFS),overall survival(OS),peritoneal recurrence rate,liver metastasis rate,gastric remnant recurrence rate,adverse reactions were examined and recorded at the time points of 12 and 24 months after the chemotherapy treatment.Results In the treatment group,disease-free survival and overall survival rates at 12 and 24 months were significantly higher than those in the control group,and the median DFS and OS were significantly longer than the control group(P<0.05).In patients with regional lymph node staging(N 2,N 3),low differentiated adenocarcinoma,tumor diameter greater than 4 cm,the disease free survival rate and overall survival rate at 12 and 24 months were significantly higher than the control group,and the median DFS and OS were significantly longer than the control group(P<0.05).In the treatment group,intraperitoneal recurrence rate and liver metastasis rate at 12 and 24 months were significantly lower than the control group(P<0.05).There was no sig

关 键 词：胃癌 腹腔灌注 化疗 维拉帕米 耐药 5-氟尿嘧啶 顺铂 亚叶酸钙 

分 类 号：R735.2[医药卫生—肿瘤]