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目的回顾性评价腹腔热灌注化疗治疗恶性腹水前后患者血清肿瘤标记物CA125、CA19-9的水平变化及其与热灌注化疗疗效的相关性。方法 2012年7月至2014年1月包头肿瘤医院确诊为腹腔转移伴腹水的患者40例,选用直径20~22mm套管针左、右侧下腹部或单侧置管,引流腹水后连通TRL 2 000热灌注化疗机,灌注0.9%氯化钠注射液1 000~2 000ml,入腹温度43℃,单循环3次。再灌注500ml 0.9%氯化钠(温度43℃)腹腔保留,同时腹腔内灌注顺铂40mg/m2+地塞米松5mg。每周1次,3周为1疗程行疗效评价,分别记录患者治疗前后血清肿瘤标记物CA125、CA19-9变化,分析临床疗效和肿瘤标记物变化的相关性。结果近期疗效:热灌注化疗治疗前、后比较,两种肿瘤标志物的血清水平差值变化显著,其中治疗前后CA125、CA19-9水平分别为(116.89±21.96)U/ml vs(101.21±11.67)U/ml和(147.91±21.13)U/ml vs(137.49±13.23)U/ml,两者比较差异有统计学意义(P<0.05);40例患者接受热灌注化疗治疗后,57.5%(23/40)患者有效,42.5%(17/40)患者进展;患者按照化疗疗效分为有效组和进展组,有效组与进展组化疗前后肿瘤标志物CA125、CA19-9差值比较,有效组肿瘤指标下降明显,两者之间的差异具有统计学意义(P<0.05);患者生存时间越长,热灌注化疗后相应的肿瘤指标下降幅度越大,患者生存时间越短,化疗后肿瘤指标下降幅度越小,甚至有上升的可能,两组比较差异有统计学意义(P<0.05)。结论 CA125和CA19-9这两种肿瘤标志物化疗前后差值与腹腔热灌注化疗疗效密切相关,可作为评价预后的指标。
Objective To retrospectively evaluate the changes of serum tumor markers CA125 and CA19-9 before and after intraperitoneal hyperthermic chemotherapy in patients with malignant ascites and its correlation with the therapeutic effect of hyperthermic perfusion chemotherapy. Methods From July 2012 to January 2014, 40 patients with peritoneal metastasis and ascites were diagnosed in Baotou Cancer Hospital. Left and right lower abdomen or unilateral catheter with diameter of 20 ~ 22mm was used. Ascites was drained and connected with TRL 2 000 hot perfusion chemotherapy machine, perfusion 0.9% sodium chloride injection 1000 ~ 2 000ml, infiltration temperature 43 ℃, single cycle 3 times. Reperfused with 500ml of 0.9% sodium chloride (temperature 43 ℃) peritoneal retention, while intraperitoneal infusion of cisplatin 40mg / m2 + dexamethasone 5mg. Once a week, 3 weeks for a course of treatment curative effect evaluation, were recorded before and after treatment of patients with serum tumor markers CA125, CA19-9 changes in clinical efficacy and tumor marker changes in the correlation. Results The short-term curative effect: Before and after treatment with hot perfusion chemotherapy, the difference of serum levels of the two tumor markers changed significantly. The levels of CA125 and CA19-9 before and after treatment were (116.89 ± 21.96) U / ml vs (101.21 ± 11.67 ), U / ml and (147.91 ± 21.13) U / ml vs (137.49 ± 13.23) U / ml respectively, there was significant difference between the two groups (P0.05) .After treatment with hot perfusion chemotherapy in 40 patients, 57.5% 23/40) patients, and 42.5% (17/40) patients. The patients were divided into effective group and progressive group according to the curative effect of chemotherapy. The differences between the effective group and the advanced group in the difference of tumor markers CA125 and CA19-9 before and after chemotherapy were significant, (P <0.05). The longer the survival time of patients, the more the corresponding tumor index decreased after thermal perfusion chemotherapy, the shorter the survival time of patients was. The tumor indexes after chemotherapy The smaller the decline rate, or even increased the possibility of difference between the two groups was statistically significant (P <0.05). Conclusion The difference between before and after chemotherapy of CA125 and CA19-9 tumor markers is closely related to the effect of intraperitoneal hyperthermic perfusion chemotherapy, which can be used as an index to evaluate the prognosis.