肿瘤细胞减灭术联合腹腔热灌注化疗对结肠癌与直肠癌腹膜转移的远期疗效比较  

The long-term clinical efficacy of tumor cytoreduction surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer

作　　者：刘帛岩 李松岩[1] 张红亮[1] 杨宇[1] 滕达[1] 刘逸尘 许晓蕾 李宇轩[1] 邢晓伟[1] 何长征[1] 王玉峰[3] 杜晓辉[1] Liu Bo-Yan;Li Song-Yan;Zhang Hong-Liang;Yang Yu;Teng Da;Liu Yi-Chen;Xu Xiao-Lei;Li Yu-Xuan;XingXiao-Wei;He Chang-Zheng;Wang Yu-Feng;Du Xiao-Hui(Department of General Surgery,the First Medical Center of Chinese PLA GeneralHospital,Beijing 100853,China;School of Medicine,Nankai University,Tianjin 300071,China;Department of Hospitalization Management,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心普通外科,北京100853 [2]南开大学医学院,天津300071 [3]解放军总医院第一医学中心住院管理科,北京100853

出　　处：《解放军医学杂志》2020年第1期79-83,共5页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(61471397)~~

摘　　要：目的比较起源于结肠与直肠的腹膜转移癌患者经肿瘤细胞减灭术(CRS)联合腹腔热灌注化疗(HIPEC)后的远期疗效差异。方法选择2012年1月1日-2013年5月31日于解放军总医院第一医学中心普通外科行CRS联合HIPEC的结直肠癌腹膜转移患者103例,根据腹膜癌的起源位置,将患者分为结肠来源组(结肠组,n=60)及直肠来源组(直肠组,n=43)。比较两组患者的手术情况[是否联合其他脏器切除、吻合口数、腹膜种植指数(PCI)、肿瘤细胞减灭完全性(CC)评级、是否输血等],术后近期并发症及远期生存情况等;采用Kaplan-Meier法绘制患者生存曲线,并用log-rank法比较两组的生存差异。结果两组患者手术相关资料(PCI、CC评级、是否肝切除、吻合口数及是否输血)差异无统计学意义(P>0.05)。103例患者的随访时间为(28.43±15.65)个月,中位生存时间(OS)为26.3个月,中位无病生存时间(DFS)为17.7个月,中位复发到死亡时间(TTD)为18.3个月,3年和5年生存率分别为35.9%和8.7%;结肠组患者的生存情况均优于直肠组(OS:28.5个月vs.19.7个月;DFS:21.1个月vs.13.6个月;TTD:22.3个月vs.12.1个月;3年生存率:48.3%vs.18.6%;5年生存率:15.0%vs.0%;均P<0.05)。结论CRS联合HIPEC治疗结肠癌腹膜转移患者的近期并发症与直肠癌腹膜转移者相当,但远期疗效优于直肠癌腹膜转移者。Objective To study the long-term efficacy of cytoreduction surgery(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) for peritoneal carcinomatosis from colorectal cancer. Methods The clinical data were collected of 103 patients with peritoneal carcinomatosis(PC) from colorectal cancer undergoing CRS with HIPEC in the Department of General Surgery of the First Medical Center of Chinese PLA General Hospital from January 1, 2012 to May 31, 2013, and divided into colonic group(n=60) and rectal group(n=43) according to the origin position of peritoneal cancer. The surgical status of patients(whether combined with other organ resection, number of stoma, peritoneal carcinomatosis index(PCI), completeness of cytoreduction(CC) score, transfusion, etc.) and the short-term complications and long-term survival after operation in the both groups were compared. Kaplan-meier method was used to draw the survival curve of patients, and log-rank method was employed to compare the survival differences between the two groups. Results There was no significant difference in the surgical data between the two groups(PCI, CC score, hepatectomy, number of anastomosed stoma, transfusion, etc., P>0.05). The follow-up time of the 103 patients was(28.43±15.65) months, median survival time(OS) was 26.3 months, median disease free survival time(DFS) was 17.7 months, median recurrence to time of death(TTD) was 18.3 months. The 3-year and 5-year survival rate were 35.9% and 8.7%, respectively. The patients’ survival was better in colonic group than in rectal group(OS: 28.5 months vs. 19.7 months;DFS: 21.1 months vs. 13.6 months;TTD: 22.3 months vs. 12.1 months;3-year survival rate: 48.3% vs. 18.6%;5-year survival rate: 15.0% vs. 0, P<0.05). Conclusion When CRS with HIPEC is implemented, the incidence of short-term complications in patients with PC originated from colon may match to those with PC originated from rectum, while the long-term efficacy is better in the former than in the latter.

关 键 词：结直肠肿瘤 腹膜转移癌 肿瘤细胞减灭术 腹腔热灌注化疗 治疗结果 

分 类 号：R735.3[医药卫生—肿瘤]