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目的观察门静脉灌注化疗联合5-氟尿嘧啶(5-FU)缓释剂区域性植入治疗进展期胃癌的疗效。方法选取2007年10月—2009年3月我科诊治的进展期胃癌患者136例,根据是否进行术中门静脉灌注化疗或5-FU缓释剂区域性植入,分为门静脉灌注化疗联合5-FU缓释剂区域性植入组37例(A组),单纯5-FU缓释剂区域性植入组34例(B组),单纯门静脉灌注化疗组33例(C组),单纯手术对照组32例(D组)。各组患者均根据肿瘤部位和侵犯程度行标准D2根治性手术,术后4周统一行5-FU、奥沙利铂(OXA)、亚叶酸钙(CF)方案(FOLFOX6方案)化疗6个周期。观察各组出现的并发症及不良反应情况,血常规及肝肾功能变化。各组患者定期复查并随访3年,了解其肝转移或局部复发情况,记录患者3年生存率。结果术后各组患者均完成了随访,无失访病例。A组肝转移或局部复发率为10.8%(4/37)、B组为29.4%(10/34)、C组为30.3%(10/33)、D组为56.3%(18/32),差异有统计学意义(χ2=16.670,P<0.05);其中A组肝转移或局部复发率低于B组、C组和D组,差异均有统计学意义(χ2值分别为3.873,4.142和16.313,P<0.05);B组和C组肝转移或局部复发率低于D组,差异均有统计学意义(χ2值分别为4.861和4.461,P<0.05)。A组3年生存率为91.9%(34/37)、B组为73.5%(25/34)、C组为72.7%(24/33)、D组为46.9%(15/32),差异有统计学意义(χ2=17.352,P<0.05);其中A组3年生存率高于B组、C组和D组,差异均有统计学意义(χ2值分别为4.254,4.510和16.894,P<0.05);B组和C组3年生存率高于D组,差异均有统计学意义(χ2值分别为4.905和4.524,P<0.05)。各组均有并发症及不良反应发生,但A、B、C组未影响术后化疗,且血常规及肝肾功能无明显异常。结论门静脉灌注化疗联合5-FU缓释剂区域性植入治疗可显著降低进展期胃癌患者肝转移或局部复发率,提高其3年生存率,效果优于单纯门静脉灌注化疗或5-FU缓释剂区域性植入,且操作简单、定位准确、安全可行,值得临床推广应用。
Objective To observe the curative effect of regional implantation of portal vein infusion chemotherapy combined with 5-fluorouracil (5-FU) sustained-release agent in advanced gastric cancer. Methods From October 2007 to March 2009, 136 patients with advanced gastric cancer undergoing radical resection in our department were divided into three groups according to whether intraoperative portal vein infusion chemotherapy or 5-FU sustained-release agent regional implantation, divided into portal vein infusion chemotherapy combined with 5- Forty-seven patients (group A) received regional implantation of FU and 34 patients (group B) received regional infusion of 5-FU sustained-release agent only, and 33 patients received simple portal vein infusion chemotherapy (group C) 32 cases (group D). Patients in each group were treated with standard D2 radical surgery according to tumor location and degree of invasion. Five cycles of 5-FU, oxaliplatin (OXA) and leucovorin (CF) regimen (FOLFOX6 regimen) . Observe the complications and adverse reactions in each group, blood and liver and kidney function changes. All patients were regularly reviewed and followed up for 3 years to understand the liver metastases or local recurrence, record the patients 3-year survival rate. Results All patients were completed follow-up, no case of follow-up. The rate of liver metastasis or local recurrence was 10.8% (4/37) in group A, 29.4% (10/34) in group B, 30.3% (10/33) in group C and 56.3% (18/32) in group D, The difference was statistically significant (χ2 = 16.670, P <0.05). The liver metastasis or local recurrence rate of group A was lower than that of group B, C and D (χ2 = 3.873, 4.142 and 16.313, P <0.05). The rates of liver metastasis or local recurrence in group B and group C were lower than those in group D (χ2 = 4.861 and 4.461, respectively, P <0.05). The 3-year survival rate was 91.9% (34/37) in group A, 73.5% (25/34) in group B, 72.7% (24/33) in group C, and 46.9% (15/32) in group D (Χ2 = 17.352, P <0.05). The 3-year survival rate of group A was significantly higher than that of group B, C and D (χ2 = 4.254, 4.510 and 16.894, respectively, P < 0.05). The 3-year survival rates of group B and group C were significantly higher than those of group D (χ2 = 4.905 and 4.524, respectively, P <0.05). Complications and adverse reactions were found in all groups. However, no effect of postoperative chemotherapy was found in groups A, B and C, and blood and liver and kidney function were not abnormal. Conclusion Regional portal vein infusion chemotherapy combined with 5-FU sustained-release agent can significantly reduce the rate of liver metastasis or local recurrence in patients with advanced gastric cancer and improve its 3-year survival rate, which is superior to simple portal vein infusion chemotherapy or 5-FU sustained release Agent regional implantation, and simple operation, accurate positioning, safe and feasible, worthy of clinical application.