结直肠癌辅助门静脉持续灌注化疗与肠腔化疗疗效的对比研究

目的　比较结直肠癌根治术后经门静脉持续灌注 5 FU 7d与术中肠腔一次给药化疗对减少术后肝转移、提高术后远期疗效的作用。方法　行根治性手术的结直肠癌患者 16 2例 ,随机分为门静脉化疗组 (A组 ) 82例和肠腔化疗组 (B组 ) 80例 ,两组的年龄、性别、肿瘤部位、肿瘤大小、Dukes′分期等差异均无显著意义 (P >0 0 5 )。A组术中经大网膜静脉向门静脉插管 ,导管远端引出腹壁固定 ,术后即从门静脉导管持续给予 5 FU 1g/d ,连续 7d ,B组术中用肠腔化疗加一次性经大网膜静脉注射 5 FU。用SPSS8 0分析比较两组的近期并发症及远期疗效。结果　A组术后并发症较多 ,但平均住院时间及生存曲线等指标两组差异无显著意义 (P >0 0 5 )。全组 5年生存率 76 7% (A组74 3% ,B组 79 2 % )。用Gehan法检验两组生存曲线 ,其差异也无显著意义。全组肝转移率为19 8%。多因素分析显示 ,影响本组预后的因素为Dukes′分期 (P <0 0 5 )。结论　结直肠癌根治术后经门静脉持续灌注 5 FU 7d的辅助化疗方法与肠腔化疗对预防肝转移、提高生存率有一定的作用 ,二者疗效相当 ,但后者更简便

Comparing the effect of adjuvant chemotherapy by portal vein infusion with intraluminal chemotherapy for colorectal cancer

OBJECTIVE: To compare the effect of 5-fluorouracil (5-FU) portal vein infusion (PVI) for 7 days after radical resection, with intraluminal chemotherapy during operation for eliminating liver metastasis and elevating long-term prognosis in colorectal cancer. METHODS: 162 colorectal cancer patients with radical resection were divided into portal vein chemotherapy group (group A, 82 cases) and intraluminal chemotherapy group (group B, 80 cases) randomly. In group A, 5-fluorouracil were infused with 1g per day constantly for 7 days after operation through portal vein catheters, which placed into greater omental vein and fixed on the abdominal wall. In group B, intraluminal chemotherapy was given and 5-fluorouracil 0.5 g was injected into the greater omental vein during operation. RESULTS: The short-term complications and long-term effect in the two groups were compared by statistical software SPSS 8.0. Group A had more operative complications, and no statistical differences was found in hospital time and survival rate of the two groups. The 5-year survival rate is 76.7% (group A: 74.3%, group B: 79.2%), and the liver metastasis rate is 19.8%. There is no significant difference between the two group-survival curves. Multiple variable analysis suggested that Dukes' stage was the prognosis factor (P < 0.05). CONCLUSIONS: The present study demonstrated that the two chemotherapy methods play an important role in preventing liver metastasis and improving the survival rate, and the intraluminal chemotherapy would be easier and simpler. The result should be further improved by using combined chemotherapy.