大肠癌病人围手术期腹腔热化疗与静脉化疗的临床对比研究

目的　系统比较结直肠癌病人围手术期腹腔温热化疗 (IPC)与全身化疗 (IVC)的优劣。方法　比较两组术前化疗后腹腔游离癌细胞的阴转率 ;术后 2周、6周时T细胞亚群及NK细胞的变化 ,骨髓抑制和消化道反应、体力状况等临床症状。结果　①术前腹腔游离癌细胞阳性者IPC组 3例 ,IVC组 2例 ,经术前IPC后开腹即时IPC组均阴性 ,而IVC组 2例仍为阳性 ;②术后 2周时外周血WBC、CD3 、CD4、CD4/CD8和NK细胞下降IVC组更明显 ,两组差异有显著意义 (P <0 0 5 ) ;③两组消化道反应和体力状况下降IPC组优于IVC组。结论　IPC能直接杀灭腹腔游离癌细胞 ,作用于腹腔及内脏微小转移灶 ,对防治大肠癌术后局部复发、腹腔及肝脏转移 ,提高手术疗效具有科学理论依据及确切的临床疗效。

Comparisive study of intraperitoneal chemotherapy and intravenous chemotherapy in patients with colorectal cancer

Objective To select an effective approach of chemotherapy to improve the prognosis in patients with resectable colorectal cancer.Methods We systematically compared the characteristics of intraperitoneal chemotherapy(IPC) and intravenous chemotherapy(IVC).Thirty-six cases with colorectal cancer were randomizely divided into group IPC and group IVC as control.They all underwent surgical resection and perioperative chemotherapy.The same dosage of 5-FU and MMC was used in group IPC and group IVC.Before and after chemotherapy,we examined the abdomen for free cancer cells in two groups.We measured the T-lymphocyte subsets,NK cells,leukocytes and observed the systemic complications and responses respectively at the time of admission,two weeks and six weeks postoperation.Results (1)In group IPC 3 patients with positive free cancer cells became negative after preoperative chemotherapy.But in group IVC,2 patients with positive free cancer cells remained positive.(2)Two weeks after operation,the values of leukocytes,CD 3,CD 4,ratio of CD 4/CD 8 and NK cells decreased,which was much lower in group IVC than those in group IPC(P<0.05).Six weeks after operation all the values mentioned above recovered to the levels before operation.(3)Nausea and vomiting were found in 2 cases of group IPC and 10 cases of group IVC.Physical status was poorer in 2 cases of group IPC and 6 cases of group IVC.(4)All patients in group IPC completed their therapeutic courses,while 4 cases in group IVC did not because of severe complications.Conclusion IPC can directly kill patients' free colorectal cancer cells in abdomen cavity and destroy the minor metatasis focuses.It has slight impairment to patients' immune function and less gastrointestinal disorders.