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目的观察比较植入用缓释氟尿嘧啶腹腔给药和腹腔内热灌注氟尿嘧啶化疗治疗晚期胃癌恶性腹水患者的近期疗效、临床获益反应及毒副反应。方法选择30例经病理组织学确诊的晚期胃腺癌腹水患者,随机分为两组,每组15例。植入用缓释氟尿嘧啶腹腔给药组:将按500mg/m2注入植入用缓释氟尿嘧啶,第14天再重复给药;热灌注化疗组:将5-FU1g溶于10%葡萄糖500ml中,加热至45℃,注入腹腔。第7天和第14天再重复给药。2周期治疗后评价疗效。结果植入用缓释氟尿嘧啶给药组和腹腔热灌注组总有效率分别为66.7%和64.2%,两组比较无显著性差异(P>0.05)。临床获益率分别为73.37%(11/15)和71.4%(10/14),两者比较无统计学差异(P>0.05)。血液系统毒性两组比较无统计学意义(P>0.05)。非血液系统毒性两组的腹泻、肾功能损害、周围神经炎、口腔黏膜炎的发生率无统计学差异(P>0.05);恶心/呕吐、肝功能损害的发生率有统计学差异(P<0.05)。结论两种方案治疗晚期胃癌恶性腹水疗效确切,均能显著改善患者的生活质量,两组对比无明显差异。毒副作用可以耐受,安全性好,但恶心/呕吐和肝功能损害的发生率在植入用缓释氟尿嘧啶腹腔给药组比腹腔内热灌注化疗组低。
Objective To compare the short-term efficacy, clinical benefit response and side effects of intraperitoneal injection of sustained-release fluorouracil and intraperitoneal hyperthermic perfusion of fluorouracil in patients with advanced gastric cancer with malignant ascites. Methods Thirty patients with advanced gastric adenocarcinoma confirmed by histopathology were randomly divided into two groups (n = 15 in each group). Intraperitoneal administration of sustained-release fluorouracil implanted group: sustained-release fluorouracil implanted at 500mg / m2, repeated administration on day 14; hot perfusion chemotherapy group: 5-FU1g was dissolved in 500ml of 10% glucose and heated To 45 ℃, into the abdominal cavity. Dose again on days 7 and 14. 2 cycles after treatment to evaluate the efficacy. Results The total effective rate was 66.7% and 64.2% in the group of sustained-release fluorouracil and intraperitoneal hyperthermic perfusion respectively. There was no significant difference between the two groups (P> 0.05). The clinical benefit rates were 73.37% (11/15) and 71.4% (10/14) respectively, with no significant difference (P> 0.05). Hematological toxicity in the two groups was not statistically significant (P> 0.05). There was no significant difference in the incidence of diarrhea, renal dysfunction, peripheral neuritis and oral mucositis between the two groups (P> 0.05). The incidence of nausea / vomiting and liver damage were statistically different (P < 0.05). Conclusion Both of the two regimens are effective in treating malignant ascites of advanced gastric cancer, which can significantly improve the quality of life of patients. There is no significant difference between the two groups. Toxicity and side effects were tolerable and safe, but the incidence of nausea / vomiting and impaired liver function were lower in the intraperitoneal hyperthermic perfusion chemotherapy group than in the intraperitoneal perfusion chemotherapy group.