胃癌并腹膜转移腹腔镜姑息性切除术后腹腔热灌注化疗的安全性及疗效

目的 探讨腹腔镜胃癌并腹膜转移姑息性切除术联合腹腔热灌注化疗的安全性与疗效.方法 回顾性分析2010年3月至2013年10月间在南方医科大学南方医院普通外科接受腹腔镜姑息性切除术后腹腔热灌注化疗（100 mg顺铂、1000 mg氟尿嘧啶、2000 ml生理盐水）的37例胃癌并腹膜转移患者的临床病理资料,观察患者近期疗效及不良反应发生情况.结果 18例患者获完全缓解,4例获部分缓解,8例疾病稳定,7例疾病进展.肿瘤总缓解率为59.5％（22/37）,Kamofsky功能状态评价获显著改善者6例,改善者13例,稳定者10例,进展者8例,改善与稳定患者占78.4％（29/37）.严重不良反应（Ⅲ/Ⅳ级）3例（8.1％）,其中腹痛2例（Ⅲ级）,恶心呕吐1例（Ⅲ级）.结论 胃癌并腹膜转移腹腔镜姑息性切除术后应用顺铂联合氟尿嘧啶方案的腹腔热灌注化疗是安全的,对延缓肿瘤进展具有一定作用.

Safety and efficacy of intraperitoneal hyperthermic perfusion chemotherapy following laparoscopic palliative resection for gastric cancer patients with peritoneal metastasis

Objective To investigate the safety and efficacy of postoperative intraperitoneal hyperthermic perfusion chemotherapy （IHPEC） following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis.Methods Between March 2010 and October 2013,37 patients with advanced gastric cancer were treated by IHPEC （cisplatin 100 mg,5-fluorouracil 1000 mg and saline 2000 mL） following laparoscopic palliative resection in our department between March 2010 and October 2013 were analyzed retrospectively.Short-term efficacy and adverse reactions were observed.Results Complete remission （CR）,partial remission （PR）,stable disease （SD） and progressive disease（PD） were found in 18,4,8 and 7 cases respectively,and the total progression-free rate was 59.5%（22/37）.The significant improved,improved,stable and progressive cases of Karnofsky performance status were 6,13,10 and 8 respectively,and the rate of improved and stable cases was 78.4%（29/37）.Serious adverse reactions （class Ⅲ or Ⅳ） were noted in 3 cases （8.1%）,including 2 cases of abdominal pain （class Ⅲ）,1 case of nausea and vomiting.Conclusions The modality of IHPEC adopting cisplatin plus 5-fluorouracil regimen following laparoscopic palliative resection for advanced gastric cancer patients with peritoneal metastasis is technically feasible and safe,which has certain effect on postponing the progression of gastric cancer.