新辅助化疗联合肿瘤细胞减灭术及术后腹腔热灌注化疗在晚期卵巢癌治疗中的应用价值分析

目的 研究新辅助化疗(NACT)联合肿瘤细胞减灭术(CDS)及术后腹腔热灌注化疗(IPHC)治疗晚期卵巢癌的临床疗效.方法 选择86例Ⅲ～Ⅳ期卵巢癌患者,依据随机数字表法将患者分为试验组(n=43)和对照组(n=43).试验组患者行NACT联合CDS及术后IPHC治疗,对照组患者行CDS联合卡铂/顺铂化疗治疗.观察两组患者的术中和术后指标、治疗前后外周血T淋巴细胞因子水平、术后不适和不良反应发生率及临床疗效.结果 试验组患者术中腹腔积液量和失血量明显少于对照组,手术时间、术后化疗疗程和住院时间明显短于对照组(P﹤0.01).试验组患者术后发热率、感染率低于对照组,术后切口Ⅱ期愈合率高于对照组(P﹤0.05).治疗后,试验组患者的CD3+CD56+、CD3+CD4+水平及CD3+CD4+/CD3+CD8+明显高于对照组,差异有统计学意义(P﹤0.01).两组患者恶心呕吐、腹泻腹痛、便秘、肝肾毒性、骨髓抑制不良反应发生率比较,差异均无统计学意义(P﹥0.05).试验组患者的客观有效率为62.79％(27/43),高于对照组的37.21％(16/43),差异有统计学意义(P﹤0.05).结论 NACT联合CDS及术后IPHC可有效清除卵巢癌细胞,改善晚期卵巢癌患者的手术指标,提高机体的免疫能力,且不良反应发生率低,疗效较好,值得临床推广.

The value of neoadjuvantchemotherapy,cytoreductive surgery and continuous hyperthermic peritoneal perfusion chemotherapy in the treatment of advanced ovarian cancer

Objective To study the clinical effect of neoadjuvantchemotherapy (NACT), cytoreductive surgery (CDS) and post-operative intraperitoneal hyperthermic perfusion chemotherapy (IPHC) in the treatment of advanced ovar-ian cancer. Method 86 cases of advanced ovarian cancer were included in this study, by random number table, the pa-tients were randomized as study group (n=43) or control group (n=43), respectively. NACT, CDS and post-operative IPHC were administered in study group, while the control group was treated with CDS combined with cisplatin and carbo-platin chemotherapy. The intra-operative and post-operative indexes, peripheral blood T lymphocyte cytokines before and after treatment, post-operative discomfort and incidence of adverse reactions as well as the clinical effect in both groups were observed. Result In study group, the intraperitoneal effusion and blood loss were significantly less, while the oper-ative time, post-operative chemotherapy cycles and hospital stay were shorter as compared with control group (P<0.01). The incidence of fever and infection after surgery in study group were lower, while stage II wound healing rate after sur-gery was higher in study group than in control group (P<0.05). After treatment, the study group had higher levels of CD3+CD56+, CD3+CD4+, and CD3+CD4+/CD3+CD8+than control group, with statistically significant difference observed (P<0.01). No significant difference was noted in regard of the incidence of nausea, vomiting, diarrhea, abdominal pain, consti-pation, liver and kidney toxicity, as well as bone marrow suppression (P>0.05). The objective response rate (ORR) in the study group was 62.79％(27/43), higher than that in the control group at 37.21％(16/43), the difference was statistically significant (P<0.05). Conclusion NACT combined with CDS and post-operative IPHC may effectively remove ovarian cancer cells to improve surgery indicators of patients with advanced ovarian cancer, which improves functional immunity, with low incidence of adverse reactions and favorable efficacy.