温热灌洗化疗及动脉插管化疗在胃肠道肿瘤中的应用

目的　探讨胃肠道癌手术切除后腹腔及肝转移的防治方法。方法　将 2 82例胃肠道癌切除术后患者分成术中腹腔温热低渗灌洗化疗加术后动脉灌注化疗组 1 69例 (治疗组 )和单纯术后静脉化疗组 1 1 3例 (对照组 ) ,对比两组局部复发率、肝转移率及 3年生存率。结果　治疗组腹腔转移率、肝脏转移率、和 3年生存率依次为 2 1 .9% ,1 2 .4 %和 74.6 % ;对照组依次为 46 .0 % ,2 7.4 %和 46 .8%(均P <0 .0 5)。结论　术中温热低渗灌洗化疗及术后动脉灌注化疗对进展期胃肠道肿瘤术后腹腔复发和肝转移有良好的防治作用。     

手术联合腹腔温热灌注化疗治疗Ⅲb，Ⅳ期胃癌的疗效观察

目的探讨Ⅲb,Ⅳ胃癌术中、术后腹腔温热灌注化疗对其术后腹膜转移和生存率的影响。方法对比研究胃癌单纯手术(对照组,31例)和手术加术中、术后腹腔温热灌注化疗(化疗组,50例)的临床资料。结果化疗组2年及3年生存率高于对照组,腹腔2年及3年复发率低于对照组。结论胃癌术中、术后腹腔温热灌注化疗对防治肿瘤腹膜转移,提高生存率有重要意义。     

胃肠道肿瘤术中温热灌洗化疗及术后动脉灌注化疗的临床研究

目的 探讨胃肠道癌术后预防腹腔转移及肝转移的方法。方法 对132例胃肠道癌切除术后病人随机分成术中腹腔温热灌洗及术后动脉灌注化疗组69例(简称治疗组)，单纯静脉化疗组63例(简称对照组)，并对其腹腔转移率、肝转移率及3年生存率进行对照研究。结果 治疗组腹腔转移率20．9％、肝脏转移率13．4％、3年生存率74．6％，对照组腹腔转移率43．8％、肝脏转移率29．4％、3年生存率49．5％。结论 术中腹腔温热灌洗及术后动脉灌注化疗对胃肠道癌病人术后腹腔转移及肝转移有良好的防治作用。     

胃癌患者术中腹腔内温热灌注化疗的临床研究

目的探讨胃癌根治术中一次性腹腔温热灌注化疗的临床疗效。方法将术中行一次性腹腔温热灌注化疗的55例胃癌患者(治疗组)与未行此方法治疗的101例患者(对照组)的腹腔游离癌细胞检出率及预后等情况进行对比。结果治疗组的温热灌注液游离癌细胞检出率为7.3%,对照组冲洗液的癌细胞检出率为30.7%(P<0.01)。治疗组与对照组术后两年内腹腔复发率分别为14.5%和38.6%(P<0.01)。治疗组术后1、2、3年生存率分别为100%、80.0%和61.8%,对照组则为96.0%、52.5%和35.6%,两组2、3年生存率比较,差异有显著性意义(P<0.01)。结论一次性腹腔温热灌注化疗简便、高效、安全,具有杀灭腹腔游离癌细胞的作用,可降低患者术后腹腔复发率和提高生存率。     

胃癌术后腹腔热灌注联合静脉化疗的应用研究

目的研究胃癌术后腹腔热灌注化疗联合静脉化疗的治疗效果。方法140例胃癌根治术后患者随机分为腹腔热灌注组(n=72)和静脉化疗组(n=68)。腹腔热灌注组患者在静脉化疗同时应用腹腔热灌注化疗,观察两组术后并发症、不良反应、术后生存率及腹腔复发率。结果两组在术后并发症及不良反应无显著性差异。术后3、5年生存率腹腔热灌注组和静脉化疗组分别为86.1%、60.2%和58.3%、29.4%(P<0.05);术后3、5年腹腔复发率分别为5.6%、27.8%和20.6%、53%(P<0.05)。结论胃癌术后腹腔热灌注联合静脉化疗可有效控制复发和转移,提高胃癌术后病人的生存率和生存质量。     

腹腔内温热免疫化疗对胃及结直肠癌腹腔内复发的防治作用

目的评价腹腔内温热化疗合并白细胞介素-2(IL-2)免疫治疗对胃及结直肠癌术后腹腔内复发的治疗或预防作用。方法将1996年1月至1998年6月以来手术切除的35例T3Ⅱ～T4ⅢB期胃癌及111例B～D期的结直肠癌患者随机分成温热化疗组及联合免疫治疗组。温热化疗在手术后全麻下进行1h,化疗药为氟尿嘧啶(5-FU)0.5g/L,丝裂霉素(MMC)8mg/L,术后第3d行IL-2腹腔内免疫治疗。将IL-2100万U加入1000ml生理盐水中滴入腹腔,隔日进行,共10次,于免疫治疗的前后应用ELISA法测定两组患者外周血中几种主要Th1型细胞因子的水平,随访比较两组患者的生存率、腹腔内复发率及肝转移发生率,进行统计学分析。结果与温热化疗组相比,联合免疫治疗组的几种主要Th1型细胞因子的水平均明显升高,差异有非常显著性意义(P<0.01);3年生存率升高13.2%,而腹腔内转移率和肝转移发生率分别下降13.5%和6.2%,差异均有显著性意义(P<0.05～P<0.01)。结论腹腔内温热化疗合并免疫治疗可促进Th1型免疫漂移,增强机体的抗肿瘤免疫功能,对预防和治疗胃及结直肠癌腹腔内复发与肝转移有一定的作用。     

胃癌腹腔游离癌细胞的检出及灭活研究

目的　探讨游离癌细胞与胃癌生物学行为的关系 ,灭活、双路化疗对预后的影响。方法　开腹后观察原发灶生物学特征 (浆膜受侵范围、形态分型、浸润深度、生长方式、淋巴转移 ) ,冲洗、涂片镜检癌细胞 ,阳性者行高温腹腔灌洗 ,术后次日行腹腔温热化疗及静脉化疗。对照组只行静脉化疗。结果　游离癌细胞检出率为 37.5 8% (5 6 /149) ,灭活率达 10 0 % ,5年生存率为 12 .5 % (7/5 6 )。对照组 5年生存率为 2 .5 % (1/40 )。结论　胃癌腹腔游离癌细胞阳性必须行灭活处理 ,早期腹腔温热化疗 ,对提高术后 5年生存率具有重要作用。     

胃癌根治术后早期复发转移的相关因素分析

目的 探讨胃癌术后早期复发转移的相关危险因素.方法 回顾性分析2001年1月至2004年12月间收治的141例行胃癌根治术后复发转移患者的临床病理资料,探讨胃癌术后早期复发(≤1年,82例)的临床病理因素及其预后.结果 早期复发组与对照组(1年后复发转移,59例)的1、3年存活率分别为36.6%、2.4%和100%、45.8%,两组存活率差异有统计学意义(P＜0.05);早期复发组、对照组复发转移后中位生存时间分别为3、5个月,两组差异有统计学意义(P＜0.05).单因素分析显示年龄、肿瘤大体分型、肿瘤部位、浸润深度、淋巴结转移、TNM分期、淋巴结转移率、术式、腹腔热灌注化疗与胃癌根治术后早期复发转移的发生相关(P＜0.05);多因素分析发现淋巴结转移、淋巴结转移率及腹腔热灌注化疗是影响胃癌根治术后早期复发转移发生的独立因素(P＜0.05).结论 早期复发转移病例生存率低、复发转移术后生存时间短.淋巴结转移、淋巴结转移率及腹腔热灌注化疗是影响胃癌根治术后早期复发转移的独立危险因素.     

进展期胃癌术中低渗温热腹腔化疗联合生物蛋白胶缓释氟尿嘧啶植入的临床研究

目的分析进展期胃癌术中腹腔内植入生物蛋白胶缓释氟尿嘧啶的安全性和治疗价值。方法对96例胃癌患者进行随机分组研究,比较三组资料的安全性指标和1、3、5年生存率、复发、转移率。结果三组资料在腹腔化疗的安全性方面均无显著性差异;治疗组术后复发率(15.15%)低于对照组A(36.36%)和对照组B(40.44%),差异有显著性意义(P<0.05)。治疗组术后1、3、5年生存率分别为86.56%、62.32%和54.17%,而对照组A术后1、3、5年生存率分别为83.98%、39.39%、30.30%,对照组B术后1、3、5年生存率分别为81.45%、29.33%、26.35%。三组1年生存率比较差异无统计学意义,而3、5年生存率比较,治疗组明显优于对照组A和对照组B(P<0.05)。结论进展期胃癌术中低渗温热腹腔化疗联合生物蛋白胶缓释氟尿嘧啶植入,安全性好,可明显降低复发率,提高患者生存率。     

Advanced gastric cancer: warm distilled water plus 5-fluorouracil intraperitoneal chemotherapy during operation

目的 评价术中热蒸馏水加氟尿嘧啶(5-FU)灌注化疗进展期胃癌的疗效.方法 对2004年1月至2006年12月期间进展期胃癌27例在术中先以热蒸馏水3000ml灌洗腹腔、吸尽冲洗液后再用生理盐水200 ml加5-FU 1000 mg灌入腹腔并保留,观察术后腹腔引流液脱落细胞及化疗毒副反应.结果 病人术后除胃肠道功能恢复时间略延长并轻度骨髓抑制外,无其它不良后果,均痊愈出院,随访5年生存率为44.4％.结论 进展期胃癌根治术中行腹腔热蒸馏水灌洗加5-FU灌注化疗安全可行,有杀灭腹腔内残余微小癌和脱落癌细胞的作用,能改善预后.     

浆膜受侵的结直肠癌术后腹腔化疗联合静脉化疗的临床研究

目的探讨术后腹腔化疗联合静脉化疗与单纯静脉化疗对浆膜受侵的结直肠癌患者的I临床疗效。方法前瞻性非随机将332例浆膜受侵的结直肠癌根治术后患者分为联合化疗组（行腹腔化疗联合静脉化疗166例）和静脉化疗组（行单纯静脉化疗166例）,比较两组患者术后腹腔局部复发率、腹腔转移率、肝及其他远处转移率和患者3年、5年总体生存率。结果联合化疗组和静脉化疗组3年、5年总体生存率：ⅡB期两组病例比较,差异无统计学意义（X^2=0.612,P=0.434）;Ⅲ期病例两组比较,差异有统计学意义（X^2=3.989,P=0.046）。联合化疗组的腹腔局部复发率（1.9％）、腹腔转移率（3.8％）和肝转移率（3.8％）均显著低于静脉化疗组的8.2％、9.5％和10.1％（P〈0.05）,而两组其他远处（肺、骨、脑）转移率（5.1％比3.8％）比较,差异无统计学意义（P〉0.05）。联合化疗组中,使用奥沙利铂组腹腔转移率和肝转移率（0.9％和0.9％）均显著低于使用顺铂组（8.8％和8.8％,P〈0.05）,两组局部复发率和远处转移率（0.9％和4.7％比3.5％和5.3％）比较,差异无统计学意义（P〉0.05）。结论联合化疗可显著降低浆膜受侵的结直肠癌根治术后患者局部复发率、腹腔转移率与肝转移率,腹腔化疗中奥沙利铂在预防腹腔广泛转移和肝转移方面较顺铂效果更佳。     

Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Intraoperative Chemotherapy for Peritoneal Carcinomatosis Arising From Colon Adenocarcinoma

Background: Hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) has been recently proposed to treat peritoneal carcinomatosis arising from colon adenocarcinoma, which is usually regarded as a lethal clinical entity. The purpose of this study was to evaluate the clinical outcome of this combined treatment.Methods: A retrospective study of 46 patients treated for peritoneal carcinomatosis from colon adenocarcinoma was performed. Thirty-four patients were treated with complete cytoreductive surgery immediately followed by intraoperative HIIC with mitomycin C and cisplatin. The clinical outcome of these 34 patients was analyzed; the median follow-up period was 14.5 months.Results: No postoperative deaths were reported. The postoperative morbidity rate was 35%. No severe locoregional or systemic toxicity was observed. The 2-year overall survival was 31%, and the median survival time and the median time to local disease progression were 18 and 13 months, respectively. Survival and local disease control in patients with well- and moderately differentiated colon adenocarcinoma were significantly better than in those with poorly differentiated tumors.Conclusions: Considering the dismal prognosis of this condition, HIIC seems to achieve encouraging results in a selected group of patients affected with resectable peritoneal carcinomatosis arising from colon adenocarcinoma. These findings support the conduction of formal phase III randomized trials.     

进展期胃肠道肿瘤术后联合化疗的临床疗效观察

目的:探讨进展期胃肠道肿瘤术后联合化疗的临床疗效。方法:自1994年1月至1999年12月我科对419例进展期胃肠道肿瘤根治术后的病例作了联合化疗。现就联合化疗对机体的耐受性、局部复发、腹腔种植转移、肝转移或其他远处转移和生存率的影响进行观察,并将之与同期行静脉化疗和腹腔化疗的病例进行分析比较。结果:联合化疗组病例的胃肠道反应、骨髓抑制和急性肾功能损害的发生率与腹腔化疗组相比无显著差异,但明显低于静脉化疗组(P<0.05)。静脉化疗组的肝转移和腹腔转移率(29.5%和32.8%)高于腹腔化疗组(14.2%和13.5%)和联合化疗组(12.8%和12.2%),而腹腔化疗组的其他远处转移率(18.4%)则远高于联合化疗组(11.5%)和静脉化疗组(9.8%)。联合化疗组病例的2、3、4及5年生存率分别为72.8%、65.1%、60.8%和55.2%,明显高于腹腔化疗组的59.2%、48.1%、43.8%和38.7%和静脉化疗组的58.9%、47.6%、42.9%和37.5%(P<0.05)。结论:进展期胃肠道肿瘤病人术后行联合化疗,降低了化疗的毒副反应,提高了病人的生活质量,有效地防止了病人术后的复发率和转移率,并延长了病人的生存期;是进展期胃肠道肿瘤根治术后较理想的化疗方式。     

活性碳吸附丝裂霉素C腹腔化疗预防进展期胃癌术后复发

目的　探讨活性碳吸附丝裂霉素C(MMC)腹腔化疗治疗和预防进展期胃癌术后腹腔复发的效果。　方法　通过随机临床试验 ,将 12 4例进展期胃癌病例随机分为 2组 ,实验组于手术结束时腹腔内给予经医用活性碳吸附的MMC 5 0mg ,术后 3个月开始常规静脉化疗。对照组仅于手术后 3周开始静脉化疗。全部病例均采取根治性手术治疗。　结果　实验组和对照组总的 3、5年生存率分别为 70 16 % ,44 5 1%和 2 7 0 9% ,14 4 5 % ,P <0 0 1。实验组较对照组 3、5年生存率分别提高 43 0 7%及 30 0 6 %。　结论　活性碳吸附MMC腹腔化疗能提高进展期胃癌根治性手术后无瘤生存率。其作用仅限于杀死腹腔内游离的癌细胞和淋巴结内微转移癌灶 ,因此主要适用于经根治手术的高危患者。     

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。     

Results of Treatment of 385 Patients With Peritoneal Surface Spread of Appendiceal Malignancy

Introduction: In the past, peritoneal carcinomatosis, regardless of primary tumor type, has always been a lethal condition. Recently, special treatments using cytoreductive surgery with peritonectomy procedures combined with perioperative intraperitoneal chemotherapy have resulted in long-term survival. Appendiceal malignancy with a low incidence of liver and lymph node metastases may be especially appropriate for these aggressive local regional treatments.Methods: All patients treated with surgery before January 1999 are included. Patients left with gross residual disease after surgery were not given intraperitoneal chemotherapy, but were later treated with intravenous chemotherapy. The intraperitoneal chemotherapy was given in the perioperative period, starting with mitomycin C at 12.5 mg/m² for males and 10 mg/m² for females. For patients whose pathology showed adenomucinosis, intraperitoneal chemotherapy was limited to treatment in the operating theater with heated mitomycin C. Patients with mucinous adenocarcinoma or pseudomyxoma/adenocarcinoma hybrid had, in addition to mitomycin C, five consecutive days of intraperitoneal 5-fluorouracil at 650 mg/m2 instilled in 1–1.5 liters of 1.5% dextrose peritoneal dialysis solution. A complete cytoreduction was defined as tumor nodules <2.5 mm in diameter remaining after surgery. The histopathology categorized the patients as having adenomucinosis, adenomucinosis/carcinomatosis hybrid, or mucinous carcinomatosis. A previous surgical score was used to estimate the extent of previous surgical procedures.Results: The morbidity of treated patients was 27% and the mortality was 2.7%. In a multivariate analysis, prognostic factors for survival included the completeness of cytoreduction (P < .0001), the histopathological character of the appendix malignancy (P < .0001), and the extent of previous surgical interventions (P = .001). Patients with a complete cytoreduction and adenomucinosis by pathology had a 5-year survival of 86%; with hybrid pathology, survival at 5 years was 50%. Incomplete cytoreduction had a 5-year survival of 20% and 0% at 10 years.Conclusions: Cytoreductive surgery and perioperative intraperitoneal chemotherapy can be used to salvage selected patients with peritoneal surface spread of appendiceal primary tumors. Similar strategies for other patients with peritoneal surface malignancy such as peritoneal carcinomatosis from colon or gastric cancer, peritoneal sarcomatosis, or peritoneal mesothelioma should be pursued.Presented at the 52nd Annual Meeting of the Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999     

术前区域性动脉灌注联合化疗治疗进展期胃癌的初步报告

目的 探讨含紫杉醇脂质体(力朴素)的联合化疗方案行术前区域性动脉灌注治疗进展期胃癌的可行性.方法 84例临床诊断Ⅱ期以上进展期胃癌患者在手术前接受区域性动脉灌注化疗,方案为:5-氟尿嘧啶(5-FU)1.1 g/m2,顺铂60 mg/m2,力朴素135 mg/m2;10～14 d后接受手术(研究组).同期收治的78例Ⅱ期以上胃癌患者行常规手术治疗(对照组).观察新辅助化疗后肿瘤原发病灶的缓解情况、毒副反应,以及两组问的疗效差异.结果 对照手术组48例(61.5%)获得根治性切除,1年总生存率为74.3%.新辅助化疗组全部完成术前区域性动脉化疗,毒性作用主要为胃肠道反应和骨髓抑制,均属可控范围内(1～2级);其中66例(78.5%)获得根治性切除,较对照手术组提高17.0%(P=0.018);1年总生存率为80.9%,较对照手术组无显著提高(P=0.283).结论 针对进展期胃癌患者,术前以力朴素联合5-FU、顺铂的方案行动脉介入化疗是安全有效的,它能提高根治手术切除率,但两组近期疗效无显著差异,可能与病例数较少和随访时间有关,尚须继续深入研究.     

Morbidity and Mortality Analysis of 200 Treatments With Cytoreductive Surgery and Hyperthermic Intraoperative Intraperitoneal Chemotherapy Using the Coliseum Technique

Background: Peritoneal carcinomatosis from gastrointestinal cancers is a fatal diagnosis without special combined surgical and chemotherapy interventions. Guidelines for cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIIC) by using the Coliseum technique have been developed to treat patients with peritoneal carcinomatosis and other peritoneal surface malignancies. The purpose of this study was to analyze the morbidity and mortality of patients undergoing cytoreductive surgery and HIIC by using mitomycin C.Methods: Data were prospectively recorded on 183 patients who underwent 200 cytoreductive surgeries with HIIC between November 1994 and June 1998. Seventeen of the 183 patients returned for a second-look surgery plus HIIC. All HIIC administrations occurred after cytoreduction and used continuous manual separation of intra-abdominal structures to optimize drug and heat distribution. Origins of the tumors were as follows: appendix (150 patients), colon (20 patients), stomach (7 patients), pancreas (2 patients), small bowel (1 patient), rectum (1 patient), gallbladder (1 patient), and peritoneal papillary serous carcinoma (1 patient). Morbidity was organized into 20 categories that were graded 0 to IV by the National Cancer Institutes Common Toxicity Criteria. In an attempt to identify patient characteristics that may predispose to complications, each morbidity variable was analyzed for an association with the 25 clinical variables recorded.Results: Combined grade III/IV morbidity was 27.0%. Complications observed included the following: peripancreatitis (6.0%), fistula (4.5%), postoperative bleeding (4.5%), and hematological toxicity (4.0%). Morbidity was statistically linked with the following clinical variables: duration of surgery (P < .0001), the number of peritonectomy procedures and resections (P < .0001), and the number of suture lines (P = .0078). No HIIC variables were statistically associated with the presence of grade III or grade IV morbidity. Treatment-related mortality was 1.5%.Conclusions: HIIC may be applied to select patients with peritoneal carcinomatosis from gastrointestinal malignancies with 27.0% major morbidity and 1.5% treatment-related mortality. The frequency of complications was associated with the extent of the surgical procedure and not with variables associated with the delivery of heated intraoperative intraperitoneal chemotherapy. The technique has shown an acceptable frequency of adverse events to be tested in phase III adjuvant trials.Presented at the 52nd Annual Meeting of Society of Surgical Oncology, Orlando, Florida, March 4–7, 1999.