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目的观察腹腔化疗对伴有血性或非血性腹水肝癌患者的疗效及安全性是否相同。方法将伴有腹水的43例肝癌患者按腹水性质及治疗方法分为4组:A组13例,为非血性腹水进行腹腔化疗组;B组15例,为非血性腹水对症治疗组;C组8例,为血性腹水进行腹腔化疗组;D组7例,为血性腹水对症治疗组。腹腔化疗均采用羟基喜树碱(HCPT)16 mg/m2、氟尿嘧啶(5-Fu)1 000 mg/m2、地塞米松10 mg,1周后重复,共2~4次。结果A组中位生存时间(MST)为4.3个月(1.8~9.3个月),腹水完全缓解(CR)1例(7.7%),部分缓解(PR)5例(38.5%),有效率46.2%,治疗期间常见副反应为白细胞、血小板下降;B组MST为2.5个月(1.7~8.3个月),腹水控制有效率0;C组MST为1.3个月(0.5~1.4个月),腹水控制有效率0,治疗期间常见副反应为恶心、呕吐以及白细胞、血小板下降;D组MST为1.8个月(0.8~2.9个月),腹水控制有效率0。结论腹腔化疗对非血性腹水的肝癌患者有一定疗效,但对血性腹水的肝癌患者疗效不佳。
Objective To observe the efficacy and safety of intraperitoneal chemotherapy in patients with hepatocellular carcinoma associated with bloody or non-bloody ascites. Methods 43 cases of hepatocellular carcinoma with ascites were divided into 4 groups according to the nature of ascites and treatment: 13 cases in group A received intraperitoneal chemotherapy for non-bloody ascites; 15 cases in group B received symptomatic treatment of non-bloody ascites; group C 8 patients were treated with intraperitoneal chemotherapy for bloody ascites; 7 patients in group D were symptomatic treatment of bloody ascites. Intraperitoneal chemotherapy with hydroxy camptothecin (HCPT) 16 mg / m2, fluorouracil (5-Fu) 1 000 mg / m2, dexamethasone 10 mg, 1 week after the repeat, a total of 2 to 4 times. Results The median survival time (MST) in group A was 4.3 months (ranged from 1.8 to 9.3 months). The complete remission (CR) in 1 patient (7.7%) and the partial response (PR) in 5 patients %, Common side effects during treatment were white blood cells, platelets decreased; B group MST 2.5 months (1.7 ~ 8.3 months), ascites control efficiency 0; C group MST 1.3 months (0.5 ~ 1.4 months) Control efficiency 0, common side effects during treatment nausea, vomiting and leukopenia, thrombocytopenia; D group MST 1.8 months (0.8 to 2.9 months), ascites control efficiency 0. Conclusion Intraperitoneal chemotherapy has certain curative effect on patients with non-bloody ascites hepatocellular carcinoma, but poor curative effect on patients with hepatocellular carcinoma due to bloody ascites.