结肠癌术后腹腔内化疗的作用

腹腔内化疗是通过腹腔内注入大量的化学药物以提高腹腔内癌灶周围局部抗癌药物的浓度 ,增加对癌细胞的细胞毒性作用 ,并可减轻肌体的毒副作用的一种治疗恶性肿瘤的有效方法。自 1998年以来 ,我们开展了腹腔内化疗 ,现总结报道如下。1　临床资料本组共 2 0例 ,其中男 12例 ,女 8例 ;年龄 32～ 78岁 ,平均 6 1岁。均为结肠癌 ,术中见肿瘤侵出浆膜层16例 ,肿瘤浸润至周围组织 3例 ,腹膜癌转移结节 1例。ＤｕｋｅｓＢ期 8例 ,ＤｕｋｅｓＣ期 12例。所有病例行根治性切除后植入腹腔内化疗泵 (ｄｒｕｇｄｅｌｉｖｅｒｓｙｓｔｅｍ ,由美国Ｂａｒｄ…     

大肠癌术后腹腔化疗病人的护理

为探讨大肠癌术后腹腔化疗的护理技术。对１９９６年５月至１９９８年６月入院治疗的３２例中、晚期大肠癌病人，在术后早期使用５－Ｆｕ和卡铂进行腹腔化疗８６４例次。结果表明，近期有效率达８７．５０％，尤其对有腹水的病人疗效显著，无明显的毒副作用。提示加强腹腔化疗管的护理，可帮助病人顺利完成化疗，取得较满意的疗效。     

结直肠癌术后腹腔化疗的疗效观察

目的　为提高结、直肠癌术后患者的临床治愈率和延长患者的生存时间。方法　对86例结直肠癌患者术后早期用五氟脲嘧淀 (5 Fu)和卡铂作腹腔化疗。结果　共完成 192 6次 ,无明显毒副作用 ,总有效率达 83.7% ,尤其是对有腹水的患者效果显著。结论　用 5 Fu加卡铂作腹腔化疗是结、直肠癌术后预防和治疗肝转移和腹腔内播散的有效化疗方式。     

大肠癌术后早期腹腔内化疗和全身化疗比较

目的 大肠癌术后早期腹腔内化疗和全身化疗疗效的比较。方法 156例大肠癌术后患者分2组分别进行腹腔内化疗和全身化疗,观察化疗引起的毒副作用、肝转移、局部复发及3年生存率。结果 腹腔内化疗较全身化疗毒副作用小,肝转移、局部复发及3年生存率分别为7.6％、2.5％、78.5％和13％、15.7％、63.6％。结论 大肠癌术后早期腹腔内化疗较全身化疗毒副作用小,肝转移和局部复发低,3年生存率较高     

术后早期门静脉化疗预防大肠癌肝转移的疗效观察

大肠癌在我国是一种常见的消化道恶性肿瘤 ,近年来发病率有上升之势 ,而肝转移是影响大肠癌患者生存期最主要的因素 ,如何有效地干预大肠癌的肝转移已成为人们关注的焦点。我院自 1994年 8月至 1996年 6月对 4 0例大肠癌患者术后早期进行 5 FU经门静脉插管辅助化疗 ,报告如下。临床资料1.一般资料 :采用随机双盲对照法将患者分为根治性切除加门静脉插管化疗组 (治疗组 )和单纯根治性切除组 (对照组 ) ,共入选 80例。经手术证实的DukesB期和DukesC期大肠癌患者治疗组 4 0例 ,男 2 3例 ,女 17例 ,年龄 16～ 74岁 ,平均年龄 4 9 8岁 ,结肠…     

大肠癌术后腹腔化疗期腹腔灌洗液癌胚抗原的临床研究

本组对 10 8例大肠癌术后患者于腹腔化疗期间连续测定腹腔灌洗液癌胚抗原 (ＣＥＡ)及血清ＣＥＡ ,研究腹腔灌洗液ＣＥＡ在大肠癌术后早期局部和腹膜隐匿性复发及肝脏微转移时的临床意义 ,为早期局部和腹膜隐匿性复发及肝脏微转移后的有效治疗提供可靠的临床依据。临床资料1.对象 :1995年 1月至 1999年 12月经手术及病理证实为大肠癌患者 10 8例。男 6 5例 ,女 43例 ,年龄 2 6～ 80岁 ,中位年龄 5 1岁。术前无明显手术禁忌证 ,无肝转移及远处脏器转移 ,均行根治性手术 ,术后常规行腹腔化疗 (ＦＤＭ方案 )。2 .方法 :对每个患者分别实施腹腔化…     

胃癌术后腹腔化疗和静脉化疗的疗效比较

目的　比较进展期胃癌术后腹腔化疗和静脉化疗的临床疗效。方法　将 68例进展期胃癌术后化疗按前瞻、随机、对照的原则分为治疗组 (腹腔化疗 ) 3 3例及对照组 (静脉化疗 ) 3 5例 ,比较两组治疗的不良反应发生率、腹腔内复发率、肝转移率、3年生存率的差异。结果　治疗组胃肠反应率、骨髓抑制率、腹腔内复发率、肝转移率、3年无瘤生存率、3年生存率分别为 12 .1%、9.0 %、18.1%、12 .1%、2 3 .6%、5 4.5 %。对照组胃肠反应率、骨髓抑制率、腹腔内复发率、肝转移率、3年无瘤生存率、3年生存率分别为 91.3 %、85 .7%、60 .0 %、3 7.1%、12 .8%、3 4.3 %。结论　与静脉化疗比较 ,进展期胃癌术后腹腔化疗的不良反应发生率、腹腔内复发率、肝转移率、3年生存率率降低 ,差异有显著性 (P <0 .0 5 )。     

术中及术后早期腹腔或盆腔热灌注化疗治疗结直肠癌的临床观察

目的:探讨术中和术后早期腹腔或盆腔热灌注化疗治疗结直肠癌的可行性、安全性、毒副作用、并发症和短期抗癌疗效.方法:对住院治疗的20例进展期结直肠癌患者行根治性或姑息性切除后,术中行腹腔热灌注化疗1次,术后4 d每日腹腔热灌注化疗1次,化疗液加热至43～44 ℃,循环灌注60～90 min,共5次;直肠癌患者术中盆腔热灌注化疗1次.结果:术中及术后早期行腹腔或盆腔热灌注化疗成功率为100%,热化疗时间内腹腔内化疗液温度均可达到41～43 ℃,并恒定保持60～90 min.热灌注化疗期间患者生命体征无明显异常,除暂时性发热、腹胀、腹痛外无其它不适,直肠癌患者盆腔少量出血1例,切口愈合延迟1例,无其它明显毒副作用及并发症.随诊率100%,随访3～17个月.其中腹腔转移2例,盆腔转移1例,局部复发率为15%,肝转移1例,肝转移率6.2%;结肠癌、直肠癌患者中各有1例分别在术后14、10个月死于全身广泛转移.结论:围手术期腹腔或盆腔热灌注化疗结直肠癌安全可行,治疗不受环境限制,并可多次进行,毒副作用小,并发症少,可能有利于杀灭腹腔内残余微小癌灶(MC)和游离癌细胞(FCC).     

术后腹腔化疗改善胃肠癌预后的疗效观察

从手术治疗的胃肠道癌患者中,随机行腹腔化疗30例(其中根治性切除23例);随机取同期常规术后静脉化疗32例(其中根治性切除26例)作对照组。术后随访对比2年以上,结果显示:1.腹腔化疗无严重并发症,而对全身尤其对骨髓毒性作用明显较静脉化疗为小。2.两组1年或2年生存率无显著差异,但在根治性切除术后患者,腹腔化疗组2年内复发或转移率显著低于对照组(P<0.05)。作者认为,腹腔化疗简便、安全、毒副作用小而近期疗效满意。     

腹腔化疗对大肠癌患者细胞免疫功能表达的影响

目的 :探讨腹腔化疗对大肠癌患者手术后免疫功能状况的影响。方法 :对 1 997年 1月至 2 0 0 2年 1 2月行根治性手术的4 8例大肠癌患者进行腹腔化疗前后细胞免疫功能检测 ,并将之与同期健康对照组和行静脉化疗病例进行比较。所有患者于化疗前 1d和化疗后 7d早晨空腹时静脉采血 ,测定血清中NK细胞和T细胞亚群。结果 :大肠癌患者手术后CD4和NK细胞水平明显低于健康人群 ;大肠癌患者化疗后CD4、CD4 /CD8和NK细胞水平低于化疗前 ,其中静脉化疗患者化疗后较化疗前明显降低 ,存在统计学意义 (P <0 0 5 ) ;而腹腔化疗组患者化疗前后上述指标的变化不大 ,无统计学意义 (P >0 0 5 )。结论 :针对大肠癌患者的免疫特点 ,采用对细胞免疫抑制较轻的腹腔化疗方式进行化疗 ,有利于大肠癌患者细胞免疫功能的恢复。     

Early Postoperative Intraperitoneal Versus Hyperthermic Intraperitoneal Chemotherapy After Optimal Cytoreductive Surgery for Colorectal Cancer with Isolated Peritoneal Metastasis (ICARuS)

Annals of Surgical Oncology -     

Failure Analysis of Recurrent Disease Following Complete Cytoreduction and Perioperative Intraperitoneal Chemotherapy in Patients with Peritoneal Carcinomatosis from Colorectal Cancer

Background The aim of this study was to analyze the anatomic distribution, timing, and outcomes of recurrent disease after complete cytoreduction and perioperative intraperitoneal chemotherapy (PIC) for peritoneal carcinomatosis of colorectal origin. Methods Data regarding all patients who underwent complete cytoreduction and PIC for carcinomatosis from colorectal cancer were extracted from a prospectively collected database. The information regarding recurrent disease found on diagnostic evaluation and/or abdominal exploration was analyzed. Results Seventy patients underwent complete cytoreduction and perioperative intraperitoneal chemotherapy, and 49 of them had documented recurrent disease. The median time to progression for these 49 patients was 9 months while their median survival was 30 months. Eighteen patients had a localized intra-abdominal recurrence, 10 had diffuse intraperitoneal recurrence, 10 had isolated distant metastases, and 11 had a combination of distant metastases and intra-abdominal recurrence. There was a statistically significant difference in survival for patients with different patterns of recurrence (P = .012). Twenty-six patients underwent a second operation. The median survival of these patients was significantly longer than that of patients who did not have a second operation (39 vs 20 months, P = .0003). Four of the 49 patients with recurrences were still alive at the time of last follow-up, and three of them have no evidence of disease 73, 96, and 206 months after the diagnosis of recurrence. Conclusions Recurrence is a frequent event after optimal cytoreduction and PIC for carcinomatosis from colorectal cancer. Surgical treatment for a selected group of patients with recurrent disease may result in long-term survival.     

Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer

Background: Aggressive treatment of peritoneal metastases from colon cancer by surgical cytoreduction and infusional intraperitoneal (IP) chemotherapy may benefit selected patients. We reviewed our institutional experience to assess patient selection, complications, and outcome.Methods: Patients having surgical debulking and IP 5-fluoro-2-deoxyuridine (FUDR) plus leucovorin (LV) for peritoneal metastases from 1987 to 1999 were evaluated retrospectively.Results: There were 64 patients with a mean age of 50 years. Primary tumor sites were 47 in the colon and 17 in the appendix. Peritoneal metastases were synchronous in 48 patients and metachronous in 16 patients. Patients received IP FUDR (1000 mg/m² daily for 3 days) and IP leucovorin (240 mg/m²) with a median cycle number of 4 (range, 1–28). The median number of complications was 1 (range, 0–5), with no treatment related mortality. Only six patients (9%) required termination of IP chemotherapy because of complications. The median follow-up was 17 months (range, 0–132 months). The median survival was 34 months (range, 2–132); 5-year survival was 28%. Lymph node status, tumor grade, and interval to peritoneal metastasis were not statistically significant prognostic factors for survival. Complete tumor resection was significant on multivariate analysis (P = .04), with a 5-year survival of 54% for complete (n = 19) and 16% for incomplete (n = 45) resection.Conclusions: Surgical debulking and IP FUDR for peritoneal metastases from colon cancer can be accomplished safely and has yielded an overall 5-year survival of 28%. Complete resection is associated with improved survival (54% at 5 years) and is the most important prognostic indicator.Presented in part at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.     

腹腔化疗对老年结直肠癌病人手术后细胞免疫功能的影响

目的：探讨老年结直肠癌病人手术后腹腔化疗对免疫状况的影响。方法：对1998年1月至2002年12月60岁以上行根治性手术的52例结直肠癌病人进行腹腔化疗前后细胞免疫检测，并将之与我院同期健康老年对照组和行静脉化疗病例进行比较。所有病人于化疗前1d和化疗后1周早晨空腹时静脉采血，测定血清中NK细胞和T细胞亚群。结果：老年结直肠癌病人手术后CD4^＋和NK细胞水平明显低于健康老年人群；老年结直肠癌病人化疗后CD4^＋、CD4^＋／CD8^＋和NK细胞水平低于化疗前，其中静脉化疗病人化疗后较化疗前明显降低，存在统计学意义（P〈0．05）；而腹腔化疗组病人化疗前后上述指标的变化不大，无统计学意义（P〉0．05）。结论：针对老年病人的免疫特点，采用细胞免疫抑制较轻的腹腔化疗方式进行化疗，对老年结直肠癌病人有一定的临床价值。     

Effects of Intraperitoneal Chemotherapy with Mitomycin C on the Prevention of Peritoneal Recurrence in Colorectal Cancer Patients with Positive Peritoneal Lavage Cytology Findings

Background

The detection of intraperitoneal free cancer cells in colorectal cancer (CRC) patients is associated with a poorer prognosis. The aim of this study was to investigate the effects of intraperitoneal chemotherapy (IPC) with mitomycin C (MMC) on preventing peritoneal recurrence in CRC patients with positive peritoneal lavage cytology findings.

Methods

A total of 52 CRC patients who had no clinically confirmed peritoneal dissemination and whose status of peritoneal lavage cytology was positive were investigated. Conventional peritoneal lavage cytology was performed. Overall, 31 of the 52 patients (59.6%) were administered IPC with MMC. Before closure of the abdomen, 4 silicon catheters were inserted into peritoneal cavity. After closure, the perfusate (diluting 20 mg MMC with 500 ml saline) was instilled from the catheter, and all catheters were clumped. All catheters were opened 1 h later.

Results

The mean follow-up period was 83.1 months. According to univariate analyses of all 52 patients and the subgroup of 36 patients with stage II or III tumors, patients with IPC had a significantly better peritoneal recurrence-free survival and cancer-specific survival than patients who did not receive IPC (P < 0.005). In multivariate analysis, IPC remained an independent prognostic factor for peritoneal recurrence-free survival in all patients.

Conclusions

It appears that IPC with MMC is an effective treatment to prevent peritoneal recurrence and prolong the cancer-specific survival in CRC patients without peritoneal dissemination, but who have positive peritoneal lavage cytology. It is necessary to verify the effectiveness of IPC with MMC in a prospective trial.     

低位直肠癌保肛扩大根治手术

探讨扩大根治术在低位直肠癌保肛手术中的临床意义。方法:在265例低位直肠癌中选择158例实施保肛手术,对其中62例在扩大根治术同时完成保肛手术。结果:总转移率54.8％。上方淋巴结转移率53.4％,侧方淋巴结转移率17.2％,下方淋巴结转移率0％,转移度9.1％。术后随访结果:扩大保肛组;3年生存率73.1％,局部复发率0％;一般保肛组:3年生存率65.2％,局部复发率5.16％。排便功能:优占80％,可占16.5％,差占3.5％。结论:扩大根治术可有效防止低位直肠癌保肛术后局部复发,术后排便功能良好,不增加手术合并症。     

Selection of Patients with Colorectal Peritoneal Carcinomatosis for Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy

Background Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy has been suggested as a treatment option for patients with colorectal peritoneal carcinomatosis. However, the survival benefit is achieved at the expense of moderate to high perioperative morbidity and mortality. Methods This review summarized the important prognostic factors for survival; outlined the patient selection process from major peritonectomy centers, paying particular attention to preoperative evaluation; and identified areas for potential improvement. Emphasis was placed on a strict patient selection process to avoid futile aggressive treatments. Results Currently, contrast-enhanced computed tomography, magnetic resonance imaging, positron emission tomography, and laparoscopy have been utilized in the preoperative evaluation process to identify potential surgical candidates. Patients with good performance status, low volume of peritoneal disease, and absence of extra-abdominal metastases are more likely to benefit from the combined treatment. Conclusions Quantitative assessment of the extent of disease is possible and should be performed at the time of primary cancer operation. Careful selection of patients to identify surgical candidates with favorable prognostic indicators is important.