进展期胃癌术中精准腹腔热灌注治疗的临床观察

发布时间：2018-07-27 20:28

【摘要】：背景在我国,绝大多数胃癌患者被确诊时已为进展期,即使行根治性切除手术,术后仍有多数患者因腹腔脱落癌细胞造成局部复发或远处转移,预后较差。因此,如何有效清除腹腔脱落癌细胞和残留微小癌灶进而防治肿瘤在腹腔内复发及转移是影响胃癌患者术后生存率的关键因素。为了防治胃癌术后腹腔复发或转移,改善进展期胃癌患者的预后,我院对进展期胃癌患者进行根治性切除术联合术中精准腹腔热灌注治疗、术后全身静脉化疗的综合治疗方案,探讨其安全性及临床疗效有利于推动此项治疗技术健康发展,促进此项技术的临床应用,使更多的胃癌患者受益。目的观察术中精准腹腔热灌注治疗联合术后全身静脉化疗与术后常规静脉化疗治疗进展期胃癌患者的效果差异,探讨术中精准腹腔热灌注治疗的安全性及有效性。方法选择南阳市中心医院普通外科自2012年03月至2013年02月收治的接受D2根治术的进展期胃癌患者96例(经病理证实),按照治疗方法的不同分为术中行精准腹腔热灌注治疗者47例(研究组),术中仅行常规腹腔冲洗者49例(对照组),两组患者均于术后3-4周按照mFOLFOX6方案行全身静脉化疗,分析两组临床资料,比较两组患者术后不良反应发生率、生存质量、并发症发生率、3年肿瘤局部复发率、远处转移率及生存率。其中不良反应包括两组患者术后未接受静脉化疗前的血常规、肝功能等血液指标及体温、血压等临床观察指标的异常和接受静脉化疗后出现的骨髓抑制、胃肠道反应等毒性反应,生存质量评估参考KPS评分标准,并发症包括吻合口瘘、切口感染、腹腔感染、肺部感染、肠梗阻。结果比较两组患者术后各种不良反应发生率,数据经统计学处理,差异无统计学意义(P0.05)。比较两组患者术后生存质量评分,研究组的总有效率为80.9%,高于对照组的61.2%,数据经统计学处理,差异有统计学意义(P0.05)。研究组术后吻合口瘘、切口感染、腹腔感染、肺部感染发生率分别为4.3%、4.3%、6.4%、8.5%,低于对照组的8.2%、6.1%、8.2%、12.2%,数据经统计学处理,差异均无统计学意义(均P0.05);研究组患者术后肠梗阻发生率为12.8%,低于对照组的30.6%,数据经统计学处理,差异有统计学意义(P0.05)。研究组患者术后3年肿瘤局部复发率、远处转移率分别为10.6%和12.8%,低于对照组的28.6%和34.7%,研究组患者术后3年生存率为68.1%,高于对照组的46.9%,数据经统计学处理,差异均有统计学意义(P0.05)。结论1.进展期胃癌患者行D2根治术后于术中行精准腹腔热灌注治疗联合术后全身静脉化疗较术后单纯行全身静脉化疗能显著提高患者术后的生存质量。2.术中精准腹腔热灌注治疗安全可行,可降低进展期胃癌患者术后肠梗阻并发症发生率,不增加患者的不良反应发生率及术后吻合口瘘、切口感染、腹腔感染、肺部感染并发症的发生率。3.术中精准腹腔热灌注治疗联合术后全身静脉化疗可提高进展期胃癌患者术后3年生存率,降低术后3年肿瘤局部复发率和远处转移率,可有效防治进展期胃癌患者术后腹腔复发和远处转移。
[Abstract]:Background in our country, most of the patients with gastric cancer have been diagnosed as progressing stage. Even after radical resection, the prognosis is poor in most patients with local recurrence or distant metastasis caused by abdominal abscission of cancer cells in the abdominal cavity. Therefore, how to effectively remove the peritoneal Exfoliative and residual cancer cells and prevent the tumor recurrence in the abdominal cavity And metastasis is the key factor affecting the postoperative survival rate of gastric cancer patients. In order to prevent the recurrence or metastasis of the abdominal cavity after the operation and improve the prognosis of the patients with advanced gastric cancer, our hospital carries out radical excision combined with accurate peritoneal heat infusion in the treatment of advanced gastric cancer, and the comprehensive treatment of postoperative whole body vein chemotherapy, and discuss the safety of the patients with advanced gastric cancer. The effect of sex and clinical effect can promote the healthy development of this treatment technology, promote the clinical application of this technique and make more patients with gastric cancer benefit. Objective To observe the difference of the effect of intraoperative precision peritoneal perfusion therapy combined with general venous chemotherapy and postoperative routine intravenous chemotherapy in the treatment of advanced gastric cancer patients after operation, and to explore the precise abdominal cavity in the operation. The safety and effectiveness of hot perfusion therapy. Methods 96 patients with advanced gastric cancer treated with D2 radical operation from 03 months to 02 months of 2013 from 2012 to 02 months in Nanyang Central Hospital were selected and 47 cases (Study Group) were treated with different treatment methods. 49 cases (control group), the two groups were treated with mFOLFOX6 regimen 3-4 weeks after the operation. The two groups of clinical data were analyzed. The incidence of adverse reactions, the quality of life, the incidence of complications, the local recurrence rate of the 3 year tumor, the distant metastasis rate and the survival rate were compared in the two groups, among which the adverse reactions included two groups of patients. The blood routine before intravenous chemotherapy, liver function and other blood indexes, abnormal clinical observation of body temperature, blood pressure and other toxic reactions such as myelosuppression and gastrointestinal reaction after intravenous chemotherapy, and quality of life assessment reference KPS score standard, complications including anastomotic fistula, incision infection, abdominal infection, lung infection, intestine The incidence of all adverse reactions after operation was compared between the two groups. The difference was not statistically significant (P0.05). The total effective rate of the two groups was 80.9%, higher than that of the control group (61.2%). The data were statistically treated with statistical significance (P0.05). The incidence of stoma fistula, incision infection, abdominal infection, and pulmonary infection were 4.3%, 4.3%, 6.4%, 8.5% respectively, which were 8.2%, 6.1%, 8.2%, 12.2% of the control group. The difference was not statistically significant (all P0.05). The incidence of intestinal obstruction after operation was 12.8% in the study group of 12.8%, lower than 30.6% in the control group, and the data were statistically treated with statistical differences. P0.05. The local recurrence rate of tumor in the 3 years after operation was 10.6% and 12.8%, respectively, 28.6% and 34.7% in the study group. The 3 year survival rate of the patients in the study group was 68.1%, higher than that of the control group (46.9%). The data were statistically significant (P0.05). Conclusion 1. advanced gastric cancer patients were treated with D2 It is safe and feasible to improve the quality of survival after the combined total venous chemotherapy after the combined operation of the combined total intravenous chemotherapy after the operation of the combined total intravenous chemotherapy compared with the total systemic venous chemotherapy after the operation. It can reduce the incidence of postoperative intestinal obstruction complications in the patients with advanced gastric cancer, and does not increase the adverse reaction of the patients with.2.. The incidence and postoperative anastomotic fistula, incision infection, abdominal infection, and the incidence of complications of pulmonary infection,.3. intraoperative intraperitoneal hyperthermic perfusion therapy combined with postoperative systemic venous chemotherapy can improve the 3 year survival rate of patients with advanced gastric cancer, reduce local recurrence rate and distant metastasis rate of 3 years after operation, and can effectively prevent and cure advanced gastric cancer patients. The intraperitoneal recurrence and distant metastasis were observed after operation.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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