卵巢癌恶性腹腔积液TP方案静脉联合循环热灌注化疗临床疗效分析

目的 恶性腹腔积液(malignant peritoneal ascites,MPE)是严重威胁晚期卵巢癌患者生存质量、生存时间的并发症之一.比较采用紫杉醇和顺铂静脉联合腹腔循环热灌注化疗与单纯腹腔灌注化疗治疗晚期卵巢癌合并恶性腹腔积液的临床疗效.方法 将2008-04-2013-07开封市中心医院收住的68例晚期卵巢癌术后复发或无法行手术治疗(合并其他远处转移无法手术、或因心肺等基础疾病无法手术、或患者、家属拒绝手术者)、合并恶性腹腔积液的患者.按照随机原则分为观察组和对照组,每组各34例.观察组采用紫杉醇联合顺铂腹腔循环热灌注化疗,对照组采用紫杉醇联合顺铂单纯腹腔灌注化疗.比较两组临床疗效、生活质量、免疫功能指标、不良反应和生存率等.结果 观察组和对照组客观缓解率分别为85.29％和58.82％,差异有统计学意义,x2=5.916 2,P＜0.05;应用SF-12生活量表评价,观察组患者在总体健康(t=3.498 6,P＜0.05)、精神健康(t=3.642 6,P＜0.05)和情感职能(t=17.523 2,P＜0.001)方面评分均高于对照组,差异有统计学意义;CD4和CD4/CD8水平,观察组治疗后高于治疗前(t=4.086 9,P＜0.05;t=2.647 9,P＜0.05),并高于对照组治疗后(t=4.279 1,P＜0.05;t=3.214 6,P＜0.05),差异有统计学意义;对照组治疗前后各免疫功能指标水平比较,差异均无统计学意义,P＞0.05;观察组和对照组不良反应发生率分别为44.05％和47.00％,差异无统计学意义,x2=0.059 3,P＞0.05;治疗组与对照组相比,1、2和3年生存率均显示优势,但差异无统计学意义.结论 紫杉醇静脉联合腹腔顺铂循环热灌注化疗治疗晚期卵巢癌疗效显著,毒副作用小,生存质量无明显下降,总体健康、精神健康、情感职能均有升高,有生存期优势,值得临床推广应用.

Clinical efficacy of TP regimen chemotherapy combined with intravenous and intraperitoneal thermal cycling perfusion in the treatment of malignant seroperitoneum effusion patients with advanced ovarian cancer

OBJECTIVE The complications of malignant peritoneal effusion could serious threaten the survival time and life quality of the patients with advanced ovarian cancer.The curative effect of the paclitaxel with cisplatin intraperitoneal thermal cycling perfusion chemotherapy versus simple intraperitoneal chemotherapy of the treatment on malignant ascites in ovarian cancer patients were explored and compared.METHODS Totally 68 cases of patients with postoperative recurrence,or combining with other distant metastasis could not be treated by surgery,or because of heart and lung and other basic diseases unable to sustain surgery,or the patient and family refused to surgery,from 2008.4 to 2013.7,were divided into two groups in the Kaifeng Central Hospital.The observation group (n=34) was given paclitaxel with cisplatin intraperitoneal thermal cycling perfusion chemotherapy,while the control group (n=34) utilized paclitaxel with cisplatin simple peritoneal perfusion chemotherapy.The clinical curative effects of two groups in life quality,immune function,adverse reactions and survival rate were compared.RESULTS The ORR was 85.29％ in the treatment group and 58.82％ in the control group with a significant difference between the two groups (x2=5.916 2,P＜0.05).According to SF-12 QoL scale results,the relevant dimensions of general health(t=3.498 6,P＜0.05),mental health(t=3.642 6,P＜0.05) and emotional function(t=17.523 22,P＜0.01) in the observation group were significantly higher than those of the control group (P＜0.05).The CD4 and CD4/CD8 levels of after treatment in the observation group were significantly higher than those of before treatment in the observation group (t=4.086 9,P＜0.05),(t=2.647 9,P＜0.05) and after treatment in the control group (t=4.279 1,P＜0.05;t=3.214 6,P＜0.05),in which the differences had statistically significance (P＜0.05),while those measures of after treatment in the control group maintained stable,which had no significant difference (P＞0.05).The rates of the side effects in the observation group and control group were 44.05％ and 47.00 ％ respectively,which was not significantly different (x2 =0.059 3,P＞0.05).Compared with the control group,the survival rate of the observation group had advantage during 1,2,and 3 years,but there was no significant difference between the two groups (P＞0.05).CONCLUSIONS The curative effects of paclitaxel combined with cisplatin intraperitoneal thermal cycling perfusion chemotherapy to treat patients with advanced ovarian cancer are remarkable.It has less side effects and the advantage of survival,overall health,mental health emotional function of the patients are increased,and the life quality of patients has no significant decline.