门静脉灌注化疗联合5一氟尿嘧啶缓释剂区域性植入治疗进展期胃癌疗效观察.pdf

Chinese General Practice
3405
全科医生技能殳展
门静脉灌注化疗联合5一氟尿蜜啶缓释剂区域性植入
治疗进展期胃癌疗效观察
邵华,何治军,苗永昌,夏春咸,王刚
摘要】目的观察门静脉灌注化疗联合5一氟尿嘧啶(5-FU)缓释剂区城性植入治疗进展期胃癌的疗效
方法选取2007年10月-2009年3月我科诊治的进展期胃癌患者136例,根据是否进行术中门静脉灌注化疗或5
FU缓释剂区域性植入,分为门静脉灌注化疗联合5-FU缓释剂区战性植入组37例(A组),单纯5-FU缓释剂区城
性植入组34例(B组),单纯门静脉灌注化疗组33例(C组),单纯手术对照組32例(D组)。各组患者均根据肿瘺
部位和侵犯程度行标准D2根治性手术,术后4周统一行5-FU、奥沙利轴(OXA)、亚叶酸钙(CF)方案( FOLFOX6
方案)化疗6个周期。观察各组出现的并发症及不良反应情况,血常规及肝腎功能变化。各组患者定期复查并随访3
年,了解其肝转移或局部复发情况,记录患者3年生存率。结果术后各组患者均完成了随访,无失访病例。A组肝
转移或局部复发率为10.8%(4/37)、B组为29.4%(10/34)、C组为30.3%(10/33)、D组为56.3%(18/32),差
异有统计学意义(x2=16.670,P<0.05);其中A组肝转移或局部复发率低于B组、C组和D组,差异均有统计学意
义(x2值分别为3.873,4.142和16.313,P<0.05);B组和C组肝转移或局部复发率低于D组,差异均有统计学意
义(x2值分别为4.861和4.461,P<0.05)。A组3年生存率为91.9%(34/37)、B组为73.5%(25/34)、C组为
72.7%(24/33)、D组为46.9%(15/32),差异有统计学意义(2=17.352,P<0.05);其中A组3年生存率高于B
组、C组和D组,差异均有统计学意义(x2值分別为4.254,4.510和16.894,P<0.05);B组和C组3年生存率高
于D銀,差异均有统计学意义(x2值分别为4.905和4.524,P<0.05)。各组均有并发症及不良反应发生,但A、B、
C組未影响术后化疗,且血常规及肝肾功能无明显异常。结论门静脉灌注化疗联合5-FU缓释荆区城性植入治疗可
显著降低迸展期胃癌患者肝转移或局部复发率,提高其3年生存率,效果优于单纯门静脉灌注化疗或5-FU缓释荆区
城性植入,且操作简单、定位准确、安全可行,値得临床推广应用。
〖关键词】胃肿瘤;化学疗法,肿,局部灌注;氟尿蜜啶;门静脉
【中图分类号R735.2【文献标识码】B【文章编号】1007-9572(2012)10-3405-03
Regional Sustained-release Chemotherapy Combined with Interventional Therapy in Treatment of Gastric Cancer
SHAO H, HE Zhi-jun, MIAO Yong-chang, et al. Departmet of Gastriestiad Su ey, the Second Hospital of Lianyun
gang, Lianyungang 222006, China
Abstracts) Objectives To explore the effect of 5-fluorouracil(5-fu) sustained release chemotherapy coupled
with in event ona erapy in treating gastric cancer(G Methods A total of 136 GC patients were divided into groups A(n
37, given chemotherapies of combined portal vein infusion and sustained-release5-fu B(n=34, given5-fu chemo-
therapy), C(n=33, given portal vein infusion), D(n=32, given peration). All patients were given standard
surgery based on tumor sites and invading degrees, and 6-cycle FOLFOX chemotherapy regime 4 weeks after operation. Com-
plications, adverse reactions and changes of blood and functions of liver and kidney were observed. Three-year survival rates
recorded. Results All groups completed follow-ups, without loss to follow cases. The rate of hepatic metastasis and local
failure was 4/37 in group A, 10/34 in group B, 10/33 in group C, 18/32 in group D, the difference was significant(X
16.670, P<0.05); thereinto lower in group A than in groups B, C, D(=3.873, 4.142, 16. 313, respectively, P
0.05); lower in groups B, C than in group D(x=4.861, 4461, respectively, P<0. 05) Three-year survival rate was
34/37 in group A, 25/34 in group B, 24/33 in group C, 15/32 in group D, the di erence was significant(x=17.352, P<
0.05) therein o higher in group A than in groups B, C D(=4.254, 4510, 16894, respectively, P<0. 05), higher
in groups B, C than in group D(X'=4.905, 4524, respectively, P <0.05) Each group had complications and adverse re-
actions, not influencing curative effects. Conclusion Chemotherapy of combined portal vein infusion and 5-FU, easy to oper-
ate, safe and feasible with accurate positioning, can reduce the rate of hepatic metastasis and local failure of advanced GC pa
tients and is worth generalizing and applying clinically
Key words] Stomach neoplasms; Chemotherapy, cancer, regional perfusion; Fluorouracil: Portal vein
d