腹腔镜胃癌根治术中联合腹腔热灌注化疗治疗进展期胃癌的疗效分析

目的探讨腹腔镜辅助术中腹腔热灌注化疗治疗进展期胃癌的疗效及其在预防胃癌复发中的作用。方法选择2013年4月—2017年4月我院收治的200例进展期胃癌患者为研究对象,随机分为观察组和对照组,各100例。观察组患者采用腹腔镜胃癌根治术联合腹腔热灌注化疗(5-氟尿嘧啶+顺铂)治疗,对照组患者仅采用腹腔镜胃癌根治术治疗,两组术后均予以奥沙利铂+替吉奥方案化疗。分别于手术前、后采集两组患者空腹静脉血,采用流式细胞术检测细胞毒T淋巴细胞相关抗原4(CTLA-4)和CD28阳性细胞数,分析手术前后两组患者免疫功能的变化,记录两组患者术后并发症及化疗毒副反应的发生情况,比较两组患者术后1年、2年生存率及复发率,并评价其生活质量。结果与手术前比较,手术后两组患者CTLA-4、CD28水平均明显降低(P<0.05);手术后,观察组患者CTLA-4水平显著低于对照组,而CD28水平显著高于对照组(P<0.05);两组患者术后并发症的发生率无明显差异(P>0.05);观察组患者术后2年生存率显著高于对照组(P<0.05),术后2年复发率低于对照组,但差异无统计学意义(P>0.05);两组患者均完成8个周期的化疗,无死亡病例,且化疗毒副反应均较轻,差异无统计学意义(P>0.05);除躯体功能评分外,两组患者术后其余各项生活质量评分比较,差异均无统计学意义(P>0.05)。结论腹腔镜辅助术中腹腔热灌注化疗治疗进展期胃癌患者的临床应用较为安全,可改善患者机体免疫功能,提高术后生存率,降低复发风险。

Therapeutic Effects of Laparoscopic Radical Gastrectomy Combined with Intraperitoneal Hyperthermic Perfusion Chemotherapy for Advanced Gastric Cancer

Objective To investigate the efficacy of intraperitoneal hyperthermic perfusion chemotherapy in the treatment of advanced gastric cancer during laparoscopic assisted surgery,and its application in the prevention of gastric cancer recurrence.Methods During the period between April 2013 and April 2017,200 patients with advanced gastric cancer admitted to our hospital were included in the study.They were randomly divided into observation group and control group,each with 100 cases.Both groups were treated with oxaliplatin plus S-1 chemotherapy after laparoscopic radical gastrectomy.Patients in observation group additionally got intraperitoneal hyperthermic perfusion chemotherapy during the surgery.The fasting venous blood of the two groups were collected before and after surgery.The CTLA-4 and CD28 positive cells were detected by flow cytometry.Changes of immune function of the two groups before and after operation were analyzed.The postoperative complications and side effects of chemotherapy in the two groups were recorded.The survival rate and recurrence rate of the patients in the 1 or 2 years after surgery were compared between the two groups,and their quality of life was evaluated.Results Compared with before surgery,the CTLA-4 and CD28 values of the two groups were significantly decreased after surgery(P<0.05).After surgery,the CTLA-4 value of the observation group was lower than that of the control group,but the CD28 value was higher than that of the control group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).The 2-year survival rate of the observation group was significantly higher than that of the control group(P<0.05).The 2-year recurrence rate of the observation group was lower than that of the control group,but there was no statistical difference(P>0.05).All the patients completed 8 cycles of chemotherapy.No deaths were observed,and the side effects of chemotherapy were mild.There were no significant differences in adverse reactions between the two groups(P>0.05).The physical function scores were significantly different between the two groups(P<0.05),but the other life quality scores showed no differences between the two groups(P>0.05).Conclusion Laparoscopic-assisted intraperitoneal hyperthermic perfusion chemotherapy is safe in the treatment of advanced gastric cancer.It can improve the immune function of patients,improve the survival rate and reduce the risk of recurrence.