应用LFHD方案静脉化疗加腹腔灌注综合治疗晚期胃癌

目的 观察全身化疗加腹腔灌注化疗(intraperitoneal chemotherapy,IPC)对晚期胃癌腹腔转移复发的治疗效果及不良反应。方法 应用LFHD方案治疗具有腹膜转移的Ⅱ～Ⅲ期胃癌术后病人30例(治疗组),用法:醛氢叶酸(Leucovorin,LV)O.2/次iv,d1-5,氟脲嘧啶(Fluorouracil,5-Fu)500 mg/m2,iv,d1-5;羟基喜树碱(Hydroxycamptothecin,HCPT)8 mg/m2,iv,d1～5;顺铂(Cisplatin,DDP)80mg/m2+NS 2000 ml(39-40℃),IPC,d,以上28d为1个周期,3个周期为1个疗程,1个疗程后DDP改为静滴。术后1.5年用2-3疗程。并与同期单纯静脉化疗病人42例(对照组)进行对照。结果 治疗组1、2及3年无瘤生存率分别为70.O％,63.3％及56.7％,均较对照组显著增高(35.7％,23.8％及21.4％)P<0.05;治疗组重度恶心、呕吐及重度骨髓抑制发生率(8/30及1/30)较对照组(31/42及12/42)显著降低(P<0.05),但腹膜炎及腹痛的发生率(30/30,30/30及0,6/42)显著增高(P<0.05)。结论 腹腔灌注化疗可提高晚期胃癌病人的近期及远期疗效;腹腔灌注化疗可引起腹膜炎及腹痛,应给予适当防治。

Treating by LFHD Regimen Advanced Gastric Carcinoma with Systemic Chemotherapy and Intraperitoneal Chemotherapy

Objective To investigate the therapeutic effect and side - effects of systemic chemotherapy plus intraperitoneal chemotherapy (IPC) in the treatment of advanced gastric carcinoma with LFHD regimen. Methods 30 postoperative patients with advanced gastric carcinoma and intraperitoneal involvement were treated by systemic chemotherapy plus IPC with LFHD regimen ( Leucovorin 0.2/time iv d1 - 5; Fluorouracil 500 mg/m2 iv d1 - 5; Hydroxycamptothecin 8 mg/m2 iv d1 - 5; Cisplatin 80 mg/m2 + NS 2000 ml at 420C IPC d1) , and another 42 patients with advanced gastric carcinoma were treated with systemic chemotherapy alone as control. Results The 1,2 and 3 yaer free - disease survival rates of the treating group (70. 0% ,63.3% and 56.7%) were higher than those in control group (35.7% ,23.8% and 21.4% ; P < 0.05) .The side-effects were mainly peritonitis and peritonealgia in the treating group, but myeosupression and digestive tract reaction were less than those in control group. Conclusions The free - disease survival rates in postoperative advanced gastric carcinoma are raised by way of systemic chemotherapy plus intraperitoneal chemotherapy ; The peritonitis is the main side effect of IPC, and should be prevented and treated properly.