胃癌术后腹膜复发转移的腹腔镜诊断和腹腔内联合全身双向化疗的临床疗效  

Laparoscopic diagnosis of postoperative recurrence of peritoneal metastasis in gastric cancer patients and the clinical efficacy of bidirectional intraperitoneal and systemic chemotherapy

作　　者：严超[1] 杨中印[1] 施敏[1,2] 徐玮[1] 倪震天 华子辰 刘文韬[1] 朱正伦[1] 毕任达[1] 郑亚南[1] 冯润华[1] 姚学新[1] 陈明敏[1] 李琛[1] 张俊[1,2] 燕敏[1] 朱正纲[1] Yan Chao;Yang Zhongyin;Shi Min;Xu Wei;Ni Zhentian;Hua Zichen;Liu Wentao;Zhu Zhenglun;Bi Renda;Zheng Yanan;Feng Runhua;Yao Xuexin;Chen Mingmin;Li Chen;Zhang Jun;Yan Min;Zhu Zhenggang(Department of Gastrointestinal Surgery,Shanghai Institute of Digestive Surgery,Shanghai Key Laboratory of Stomach Neoplasm,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Oncology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院胃肠外科,上海消化外科研究所,上海市胃肿瘤重点实验室,200025 [2]上海交通大学医学院附属瑞金医院肿瘤科,200025

出　　处：《中华胃肠外科杂志》2020年第5期492-498,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81772518);上海交通大学医学院多中心临床研究项目(DLY201602)。

摘　　要：目的:探讨胃癌术后腹膜复发转移腹腔镜诊断的价值和腹腔内联合全身双向化疗(BIPS)的临床疗效。方法:采用描述性病例系列研究的方法。病例纳入标准:(1)既往接受胃癌D 2根治术,无同时性远处转移;(2)胃癌手术后接受辅助化疗;(3)除腹膜复发转移外,无其他远处转移征象;(4)年龄18~75岁;(5)美国东部肿瘤协作组(ECOG)活动状态评分≤2分;(6)治疗前评估认为可耐受手术和化疗。上海交通大学医学院附属瑞金医院胃肠外科2015年9月至2016年9月间,连续收治且符合上述标准的8例胃癌术后腹膜复发转移患者纳入研究。其中男性6例,女性2例;中位年龄52(38~68)岁。8例患者先接受腹腔镜或者剖腹探查,参照Sugarbaker腹膜癌指数(PCI)和日本胃癌研究会制定的胃癌腹膜转移分级进行评估,于下腹部皮下埋置腹腔化疗泵,接受21 d为1疗程的化疗。化疗第1和第8天,经化疗泵向腹腔内输注紫杉醇(20 mg/m^2),并经静脉输注紫杉醇(50 mg/m^2);同时,连续14 d每日口服替吉奥(80 mg/m^2),休息7 d。随访截止日期为2019年12月15日。结果:8例胃癌术后腹膜复发转移患者中,1例由于存在完全性结肠梗阻,接受剖腹探查+末端回肠袢式造口术,其余7例均成功行腹腔镜探查并明确诊断腹膜复发转移;2例同时伴有卵巢转移者接受腹腔镜下双侧附件切除术。中位随访时间为17.5(1.5~39.0)个月,BIPS中位疗程数为11(1~30)个疗程,BIPS治疗后的中位生存时间为17.0个月。BIPS治疗的严重不良反应主要是骨髓抑制,其中3~4级白细胞减少症和中性粒细胞减少症分别为1例和2例。所有病例均未发生BIPS治疗相关的死亡。胃癌术后的总体生存的中位时间为40.0个月。结论:腹腔镜探查用于胃癌术后腹膜复发转移的诊断安全、可行;BIPS对胃癌腹膜复发转移的治疗有效且安全。Objective To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer,and to investigate the efficacy of bidirectional intraperitoneal and systemic(BIPS)chemotherapy for the recurrence.Methods The descriptive case series study was conducted.Case inclusion criteria:(1)gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy;(2)postoperative adjuvant chemotherapy was administered;(3)no other distant metastasis except recurrence of peritoneal metastasis;(4)age of 18-75 years;(5)Eastern Cooperative Oncology Group(ECOG)performance-status score≤2;(6)pretreatment evaluation suggested that surgery and chemotherapy could be tolerated.Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study.There were 6 males and 2 females with the median age of 52(38-68)years.They received laparoscopy or laparotomy first,and then were evaluated with reference to the Sugarbaker peritoneal cancer index(PCI)and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association.A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment.All the patients received intraperitoneal 20 mg/m^2 of paclitaxel(PTX)via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m^2 of PTX at day 1 and day 8,meanwhile 80 mg/m^2 of Tigio was orally administered per day for 14 consecutive days,followed by 7 days of interval.Follow-up ended on December 15,2019.Results Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery,1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction,and the remaining 7 cases underwent laparoscopy

关 键 词：胃肿瘤 腹膜转移 化疗 腹腔镜 

分 类 号：R735[医药卫生—肿瘤]