术中腹腔热灌注化疗联合全腹腔镜下胃癌D2根治术治疗胃癌的临床分析  

Clinical analysis of intraoperative hyperthermic intraperitoneal chemotherapy combined with total laparoscopic D2 radical gastrectomy in treatment of gastric cancer

作　　者：柏巍松[1] 申力[1] 唐纪全[1] 王志伟[1] 王守立[1] 赵立志[1] 申志成 Bai Weisong;Shen Li;Tang Jiquan;Wang Zhiwei;Wang Shouli;Zhao Lizhi;Shen Zhicheng(Department of Digestive Surgery,the Central Hospital of Hanzhong in Shaanxi Province,Hanzhong 723000,China)

机构地区：[1]陕西省汉中市中心医院消化外科,723000

出　　处：《肿瘤研究与临床》2021年第11期834-839,共6页Cancer Research and Clinic

摘　　要：目的探讨术中腹腔热灌注化疗联合全腹腔镜下胃癌D2根治术治疗胃癌的疗效及安全性。方法回顾性分析汉中市中心医院2017年8月至2019年7月收治的127例胃癌患者临床资料。所有患者均完成全腹腔镜下胃癌D2根治术,其中58例患者行全腹腔镜下胃癌D2根治术联合术中腹腔热灌注化疗(观察组),69例患者仅行全腹腔镜下胃癌D2根治术(对照组)。观察两组患者手术情况及术后恢复情况、术后肿瘤相关指标。采用门诊和电话方式进行随访,随访内容包括患者辅助化疗、肿瘤复发及转移、手术相关并发症情况。结果观察组术中出血量(199±48)ml,淋巴结清扫数目(35±8)枚,住院总费用(53261±4316)元,丙氨酸氨基转移酶(30±10)U/L,肌酐(124±26)μmol/L;对照组术中出血量(184±46)ml,淋巴结清扫数目(34±13)枚,住院总费用(52146±4817)元,丙氨酸氨基转移酶(31±10)U/L,肌酐(128±33)μmol/L;两组间差异均无统计学意义(t值分别为1.833、0.618、1.363、0.721、0.856,均P>0.05)。观察组手术时间(352±44)min,术后1个月癌胚抗原(CEA)(3.9±2.1)ng/ml,术后6个月CEA(12.7±7.2)ng/ml,术后1个月异常糖链糖蛋白(TAP)(75±36)μm^(2),术后6个月TAP(131±33)μm^(2);对照组手术时间(308±58)min,术后1个月CEA(8.3±4.5)ng/ml,术后6个月CEA(15.8±4.2)ng/ml,术后1个月TAP(88±24)μm^(2),术后6个月TAP(149±37)μm^(2);两组间差异均有统计学意义(t值分别为4.792、7.185、2.832、2.284、2.984,均P<0.05)。127例患者均获得随访,随访时间12~24个月。观察组和对照组分别有51例和58例患者接受术后辅助化疗,两组比较差异无统计学意义(χ^(2)=0.389,P=0.533)。观察组术后6个月无复发,对照组复发6例;两组术后1年复发分别为2例和11例;两组复发率比较,差异均有统计学意义(均P<0.05)。结论术中腹腔热灌注化疗联合全腹腔镜手术治疗胃癌,不增加患者围术期风险和术后并发症的发生率,可减低术后复发的风Objective To explore the efficacy and safety of intraoperative hyperthermic intraperitoneal chemotherapy combined with total laparoscopic D2 radical gastrectomy in the treatment of gastric cancer.Methods The clinical data of 127 patients with gastric cancer who were admitted to the Central Hospital of Hanzhong in Shaanxi Province from August 2017 to July 2019 were retrospectively analyzed.All patients underwent total laparoscopic D2 radical gastrectomy,of which 58 patients underwent total laparoscopic D2 radical gastrectomy combined with intraoperative hyperthermic intraperitoneal chemotherapy(observation group),and 69 patients underwent total laparoscopic D2 radical gastrectomy(control group).Observation indicators included surgical and postoperative recovery situations and postoperative tumor⁃related indicators.Follow⁃up was performed by using outpatient examination and telephone interview,and the content of follow⁃up included patient's adjuvant chemotherapy,tumor recurrence and metastasis,and surgery⁃related complications.Results In the observation group,the intraoperative blood loss was(199±48)ml,the number of lymph node dissection was 35±8,the total hospitalization cost was(53261±4316)yuan,alanine aminotransferase was(30±10)U/L,and creatinine was(124±26)μmol/L;in the control group,the intraoperative blood loss was(184±46)ml,the number of lymph node dissection was 34±13,the total hospitalization cost was(52146±4817)yuan,alanine aminotransferase was(31±10)U/L,and creatinine was(128±33)μmol/L;there were no significant differences between the two groups(t values were 1.833,0.618,1.363,0.721,and 0.856,all P>0.05).In the observation group,the operating time was(352±44)min,carcinoembryonic antigen(CEA)at 1 month after operation was(3.9±2.1)ng/ml,CEA at 6 months after operation was(12.7±7.2)ng/ml,tumor abnormal protein(TAP)at 1 month after operation was(75±36)μm^(2),TAP at 6 months after operation was(131±33)μm^(2);in the control group,the operating time was(308±58)min,CEA at 1 month afte

关 键 词：胃肿瘤 腹腔镜 化学疗法 癌 局部灌注 肿瘤标记 生物学 预后 

分 类 号：R735.2[医药卫生—肿瘤]