进展期胃癌术中腹腔内及门静脉灌注化疗的临床价值

目的探讨进展期胃癌术中行腹腔内注入药物及门静脉灌注化疗防治腹膜腔种植转移和肝转移的临床作用.方法对280例进展期胃癌患者中147例行开腹后腹膜腔内注入化疗药物丝裂霉素(MMC)20 mg,使整个手术操作在腹腔内有化疗药物的条件下进行,并术中经横结肠系膜静脉插管行门静脉灌注MMC 20 mg,防治肝转移;另133例不行以上药物腹腔注入和门静脉灌注,进行对照观察.结果两组3年生存率分别为54.4%和40.6%(P=0.034),腹膜腔内种植转移、转移复发发生率分别为5.4%和13.5%(P=0.017),肝转移发生率分别为4.1%和12.7%(P=0.009).结论进展期胃癌术中行腹腔内化疗药物灌注,使整个手术在抗癌药物浸泡的腹腔内完成,是防止癌腹膜腔复发、种植转移的有效方法.门静脉灌注化疗防治肝转移是积极、有效的措施.

Effects of intraoperative peritoneal chemotherapy and portal vein infusion chemotherapy on progressing gastric cancer

Objective To evaluate the efficacy of intraoperative peritoneal chemotherapy (IPC) and portal vein infusion chemotherapy (PVIC) in prevention and treatment of peritoneal implantation and liver metastases of the gastric cancer.Methods A prospective randomized study comparing the results of 147 patients receiving IPC and PVIC, with the results of 133 patients receiving operation only. Results 280 patients of both groups underwent surgical radical resection for advanced gastric cancer.The overall 3-year survival rates were 54.4% for the group receiving IPC and PVIC and 40.6% for the group receiving operation only. The incidences of intraperitoneal implantation were 5.4% in group of IPC and PVIC and 13.5% in group of operation only.Liver metastases rates were 4.1% and 12.7% (P<0.05) respectively. Conclusion IPC and PVIC is an effective method for prevention and treatment of advanced gastric cancer.