持续腹腔热灌注化疗治疗进展期胆管癌的临床疗效观察

目的 探讨持续腹腔热灌注化疗(CHPPC)治疗进展期胆管癌的临床疗效及对患者生存时间的影响.方法 回顾性分析我院2014年8月至2016年6月收治的103例进展期胆管癌患者的临床资料,其中46例患者给予CHPPC治疗(CHPPC组),另57例给予常规静脉化疗(对照组).比较两组患者的生活质量KPS评分、临床疗效、肝功能指标[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、γ-谷氨酰转移酶(γ-GT)、总胆红素(TB)、碱性磷酸酶(ALP)]和血清糖类抗原19-9(CA19-9)指标变化,以及不良反应发生情况.比较两组患者的生存时间.结果 CHPPC组的生活质量改善率为34.78％(16/46),高于对照组的19.30％(11/57,P＜0.05).CHPPC组治疗有效率为67.39％(31/46),高于对照组的40.35％(23/57,P＜0.01).CHPPC组的AST、ALT、γ-GT、TB、ALP及CA19-9中位数水平均低于对照组(P＜0.05).CHPPC组白细胞减少、血小板减少及肝功能损伤发生率低于对照组(P＜0.05),两组血红蛋白减少、胃肠道反应和肾功能损伤的发生率差异无统计学意义(P＞0.05).CHPPC组的生存时间为(12.00±2.47)个月,长于对照组的(6.00±0.80)个月(P＜0.01).结论 CHPPC治疗进展期胆管癌临床疗效较常规静脉化疗显著,患者的血清CA19-9水平下降,肝功能及生活质量改善,生存时间延长,值得推广应用.

Clinical efficacy of continuous hyperthermic peritoneal perfusion chemotherapy in the treatment of advanced cholangiocarcinoma

Objective To explore the clinical efficacy of continuous hyperthermic peritoneal perfusion chemotherapy (CHPPC) in the treatment of advanced cholangiocarcinoma and its long-term impact on survival time.Methods This was a retrospective study of 103 patients with advanced cholangiocarcinoma from Aug.2014 to Jun.2016 in Eastern Hepatobiliary Surgery Hospital of Second Military Medical University.The 46 patients in CHPPC group underwent CHPPC and 57 patients in control group received conventional intravenous chemotherapy.We recorded and analyzed the quality of life (KPS score),clinical efficacy,liver function indexes (including aspartate aminotransferase [AST],alanine aminotransferase [ALT],γ-glutamyl transferase [γ-GT],total bilirubin [TB] and alkaline phosphatase [ALP]),serum carbohydrate antigen 19-9 (CA19-9),adverse reaction and survival time of the patients in the two groups.Results The improvement rate of quality of life in the CHPPC group was significantly higher than that in the control group (34.78％[16/46] vs 19.30％[11/57],P＜0.05).The effective rate of the CHPPC group was significantly higher than that of the control group (67.39％[31/46] vs 40.35％[23/57],P＜0.01).The median levels of AST,ALT,γ-GT,TB,ALP and CA19-9 in the CHPPC group were significantly lower than those in the control group (P＜0.05).The incidences of aleucocytosis,thrombocytopenia and liver function injury in the CHPPC group were significantly lower than those in the control group (P＜0.05),and there was no significant difference between two groups in the incidence of reduction of hemoglobin,gastrointestinal adverse reaction or renal injury (P＞0.05).The survival time of the patients in the CHPPC group was significantly higher than that in the control group ([12.00 ± 2.47] months vs [6.00± 0.80] months,P ＜ 0.01).Conclusion CHPPC shows a significant clinical efficacy in the treatment of advanced cholangiocarcinoma.It can effectively decrease the median level of serum CA19-9,improve the liver function and quality of life,and prolong the survival time of the patients.