进展期结直肠癌患者根治术后行预防性腹腔热灌注化疗的安全性评价  

Safety evaluation of preventive intraperitoneal hyperthermic perfusion chemotherapy in patients with advanced colorectal cancer after radical resection

作　　者：林曜 郭熙恺 沈楚 李源 王点石 胡鹏 王征[1] 吴轲 吴川清 陶凯雄[1] Lin Yao;Guo Xikai;Shen Chu;Li Yuan;Wang Dianshi;Hu Peng;Wang Zheng;Wu Ke;Wu Chuanqing;Tao Kaixiong(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022

出　　处：《中华结直肠疾病电子杂志》2021年第6期591-598,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金(No.81600401,No.81874184)。

摘　　要：目的本研究旨在探讨进展期结直肠癌患者根治术后行腹腔内灌注化疗(HIPEC)预防腹膜转移的围手术期安全性。方法本研究回顾性分析了2020年1月至2021年2月于华中科技大学同济医学院附属协和医院胃肠外科123例行根治手术+HIPEC治疗的局部进展期结直肠癌患者的病例资料。并按美国卫生及公共卫生部公布的常见不良事件评价标准(CTCAE 5.0)对进展期结直肠癌患者围手术期安全性进行评价。通过logistics模型分析局部进展期结直肠癌患者不良事件发生的独立危险因素。结果123例患者均行根治术+HIPEC。共有45例(36.6%)进展期结直肠癌患者术后发生2级及以上不良事件。患者术后平均住院时间为(11.7±4.30)天。对行1~3次HIPEC患者的不良事件发生率进行差异分析结果表明Ⅱ度骨髓抑制发生率差异有统计学意义(χ^(2)=7.303,P=0.012)。经过单因素及多因素logistics分析,结果表明女性(OR=3.280,95%CI:1.355~7.939,P=0.007)是局部进展期结直肠癌患者根治术后行HIPEC治疗的不良事件发生的独立危险因素,18.5 kg/m^(2)≤BMI≤24.0 kg/m^(2)(OR=0.155,95%CI:0.041~0.587;P=0.011)则属于独立保护因素。结论进展期结直肠癌患者根治术后行HIPEC并没有显著增加常见术后并发症的发生率,但围手术期行3次HIPEC的进展期结直肠癌患者Ⅱ度骨髓抑制显著高于行1次或2次。同时,临床医师应密切关注女性或BMI过低(或过高)的进展期结直肠癌患者根治术后行HIPEC治疗时的不良事件发生率。Objective This study aimed to explore the perioperative safety of radical resection combined with hyperthermic intraperitoneal chemotherapy(HIPEC)in the treatment and prevention of peritoneal metastasis in patients with advanced colorectal cancer.Methods This study retrospectively analyzed 123 patients with radical surgery+HIPEC locally advanced colorectal cancer in the Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to February 2021.The perioperative safety of patients with advanced colorectal cancer was evaluated according to common terminology criteria for adverse events(CTCAE 5.0)published by the US Department of Public Health.We analyzed the independent risk factors of adverse events in patients with locally advanced colorectal cancer through the logistics model.Results All 123 patients underwent radical resection+HIPEC treatment.A total of 45 cases(36.6%)of advanced colorectal cancer patients had adverse events of grade 2 and above after surgery.The average postoperative hospital stay was(11.7±4.30)days.The difference analysis of the incidence of adverse events in patients undergoing 1~3 times of HIPEC showed that there was a significant difference in the incidence of gradeⅡbone marrow suppression(χ^(2)=7.303,P=0.012).Univariate and multivariate logistics analysis showed that women(OR=3.280,95%CI:1.355~7.939,P=0.007)was an independent risk factor for adverse events in locally advanced colorectal cancer patients treated with HIPEC after radical surgery,while 18.5 kg/m^(2)≤BMI≤24.0 kg/m^(2) was an independent protective factor(OR=0.155,95%CI:0.041~0.587,P=0.011).Conclusion Radical surgery combined with HIPEC in the treatment of advanced colorectal cancer patients did not significantly increase the incidence of common postoperative complications.However,the second-degree myelosuppression of advanced colorectal cancer patients who received 3 times of HIPEC during the perioperative period was significantly higher

关 键 词：结直肠肿瘤 腹腔内灌注化疗 进展期 安全性 

分 类 号：R735.34[医药卫生—肿瘤]