术中腹腔内温热化疗对进展期胃癌的临床疗效研究

目的 探讨术中腹腔内温热化疗（IPHC）治疗进展期胃癌的临床疗效。方法 1998年至2001年手术切除的T3、T4胃癌118例。将无腹膜转移的96例作为预防性研究组，其中42例行IPHC，54例单纯手术作对照，随访观察术后生存情况和IPHC对腹膜复发的预防作用；将有腹膜转移的22例作为治疗性研究组，其中10例行IPHC，12例作对照，观察术后生存期。同时对全组IPHC（52例）和单纯手术者（66例）进行总的生存分析比较。结果 预防性研究组中，IPHC者术后1、2、4年生存率为85．7％、81．0％和63．9％，优于单纯手术者（77．3％、61．0％和50．8％）。C0x模型提示，IPHC是T3、T4胃癌的独立预后因素；术后腹膜复发率10．3％，低于单纯手术者的34．7％。治疗性研究组中，IPHC者术后生存时间（中位生存期10个月）较单纯手术者（中位生存期5个月）长。全组IPHC病例总的术后1、2、4年生存率（76．9％、69．2％和55．2％）高于单纯手术的病例（66．2％、49．7％和41．4％）。结论 IPHC可提高B、L胃癌患者的生存率，延长生存期。

Clinical effect of intraoperative peritoneal hyperthermic chemotherapy for advanced gastric cancer

Objective To investigate the clinical effect of intraoperative peritoneal hyperthermic chemotherapy (IPHC) for advanced gastric cancer(AGC). Methods A total of 118 AGC patients with serosal invasion were enrolled in this study from 1998 to 2001. Among these cases,96 patients without macroscopic peritoneal metastases were selected for prophylactic study,including 42 cases with IPHC and 54 cases without IPHC as control. Other 22 patients with macroscopic peritoneal metastases were selected for therapeutic study,including 10 cases with IPHC and 12 without IPHC. Postoperative survival rate and peritoneal recurrence were compared. Results For prophylactic study,the 1,2 and 4 years survival rates were 85.7%,81.0%and 63.9%respectively in the patients with IPHC,significantly higher than 77.3%,61.0%and 50.8%in the patients without IPHC. Cox ratio hazard model revealed that IPHC procedure was an independent prognostic factor. More patients in the control group suffered from peritoneal recurrence than those in IPHC group (34.7%vs 10.3%). For therapeutic study,the median survival period of the patients with IPHC was 10 months,higher than 5 months in the patients without IPHC. The overall 1,2,4 year survival rates were 76.9%,69.2%,55.2%respectively in all cases with IPHC,higher than 66.2%,49.7%,41.4%in the cases without IPHC. Conclusion IPHC procedure can improve the prognosis of AGC patients with serosal invasion,reduce the risk for peritoneal recurrence,and is an independent prognostic factor.