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。

Clinical Study of the Effect of Postoperative Combined Chemotherapy for Patients with Advanced Gastrointestinal Carcinoma

Objective:To elevate the effects of postoperative combined chemotherapy for patients with advanced gastrointestinal carcinoma.Methods:From Jan.1992to Dec.1997,419patients with advanced gastrointestinal carcinoma were treated,in addition to radical surgery with intraperitoneal chemotherapy,intravenous chemotherapy or combined chemotherapy.The tolerance to therapeutic regimens,occurrence of local metastases,peritoneal metastases,hepatic metastases and other distant metastases was observed.The2-,3-4.and5-year survival rates were analyzed.Results:Peritoneal and hepatic metastases combined chemotherapy(12.2%,12.8%)and intraperitoneal chemotherapy(13.5%,14.2%)groups than in the intravenous chemotherapy groups(32.8%,29.5%)(P<0.05).Excluding hepatic metastases,the distant metastasis rate except hepatic metastases of the intraperitoneal chemotherapy groups(18.4%)was much higher than that of the intravenous chemotherapy(9.8%)or the combined chemotherapy(11.5%)groups.The2-,3-,4-and5-year survival rate of the combined chemotherapy group(72.8%,65.1%,60.8%,55.2%)were much higher than those of the intravenous chemotherapy(58.9%,47.6%,42.9%,37.5%)and intraperitoneal chemotherapy(59.2%,48.1%,43.8%,38.7%)groups.Conclusions:Patients with advanced gastrointestinal carcinoma were adaptable to combined chemotherapy after radical operation.It had caused less side-effects,a lower peritoneal metastasis rate,a lower hepatic metastasis rate,a lower level of serum CEA and CA19-9,and a higher5-year survival rate.