189例胃肠恶性肿瘤患者的腹腔热灌注化疗临床分析  

Clinical analysis of hyperthermic intraperitoneal chemotherapy for 189 patients with gastrointesti-nal malignant tumors

作　　者：袁建保 罗伟[2] 莫慧[2] 潘可[2] 韩浩言 段伦喜[2] YUAN Jianbao;LUO Wei;MO Hui;PAN Ke;HAN Haoyan;DUAN Lunxi(Gastroenterology Department,Shimen County People's Hospital,Changde 415300,Hunan,China;Gastroenterology Department,the Second Xiangya Hospital,Central South University,Changsha 410011,Hunan,China)

机构地区：[1]石门县人民医院胃肠外科,湖南常德415300 [2]中南大学湘雅二医院胃肠外科,湖南长沙410011

出　　处：《中国现代手术学杂志》2024年第2期85-90,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的研究腹腔热灌注化学治疗(hyperthermic intraperitoneal chemotherapy,HIPEC)对胃肠恶性肿瘤患者的疗效及安全性。方法回顾性分析中南大学湘雅二医院和石门县人民医院胃肠外科2021年1月至2023年1月收治的319例恶性肿瘤患者的临床资料。189例接受HIPEC治疗(HIPEC组,其中HIPEC+静脉化疗组111例,单纯HIPEC组78例),100例接受静脉化疗(静脉化疗组),30例接受姑息治疗(姑息治疗组)。随访患者的生存状态,并进行影响因素分析。结果319例患者术前及术中均观察到肿瘤的广泛转移及播散,162例患者的原位肿瘤得以完整切除,36例术后出现并发症。HIPEC组中位生存时间为17.0个月,静脉化疗组和姑息治疗组的中位生存时间分别为11.9个月和5.6个月。性别、年龄、BMI、肿瘤大小、并发症、住院时间、基础疾病、腹水、既往手术史、术前术后是否完善其他方案的化疗与患者预后无显著性相关(P>0.05)。细胞分化程度、有无肝、肺、骨远处转移、原位肿瘤切除与否与预后有显著性相关(P<0.05)。结论在终末期胃肠肿瘤患者中,HIPEC能显著提高中位生存时间,且肿瘤细胞高分化、中高分化组和无肝、肺、骨转移的患者可以从中获益,而有肝、肺、骨转移的患者则不能获益,原位肿瘤切除后接受腹腔热灌注化疗可以延长患者生存时间。Objective To explore the efficacy and safety of hyperthermic intraperitoneal chemotherapy(HIPEC)for patients with gastrointestinal malignant tumors.Methods A retrospective analysis was conducted on the clinical data of 319 patients with malignant tumors admitted to the Gastroenterology Department of the Second Xiangya Hospital of Central South University and Shimen County People's Hospital from January 2021 to January 2023.189 cases received HIPEC treatment(the HIPEC group,including 111 cases of the HIPEC+intravenous chemotherapy group and 78 cases of the simple HIPEC group),100 cases received intravenous chemotherapy(the intravenous chemotherapy group),and 30 cases received palliative treatment(the palliative treatment group).The survival status of patients was followed up and analysis of influencing factors were conducted.Results Extensive metastasis and dissemination of tumors were observed in 319 patients before and during surgery.In situ tumors were completely removed in 162 patients,and postoperative complications occurred in 36 patients.The median survival time of the HIPEC group was 17.0 months,while the intravenous chemothera-py group and the palliative treatment group was 11.9 months and 5.6 months,respectively.There was no sig-nificant correlation(P>0.05)between the patients'prognosis and gender,age,BMI,tumor size,complica-tions,length of hospital stay,complicated disease,ascites,previous surgical history,or other chemotherapy regimens.The degree of cell differentiation,the presence of liver,lung,and distant bone metastasis,and the in situ tumor resection was significantly correlated with prognosis(P<0.05).Conclusions In patients with end-stage gastrointestinal tumors,HIPEC can significantly improve median survival time,and patients without liver,lung,or bone metastasis or the highly differentiated and mediumly to highly differentiated tumor cell groups can benefit from it.HIPEC after in situ tumor resection can prolong the survival time.

关 键 词：腹腔热灌注化学治疗 胃肠道肿瘤 并发症 生存率 

分 类 号：R735[医药卫生—肿瘤]