CAJ | 학술논문

目的观察细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC)治疗胃癌腹膜转移癌(PC)的疗效和安全性.方法取成年雄性新西兰大白兔42只,将VX2癌细胞注入胃窦部黏膜下,制成溃疡型胃癌PC模型,随机分为空白组(n=14)、单纯CRS组(n=14)、CRS+HIPEC组(n=14).种瘤后第8～9天行治疗,HIPEC药物为多西紫杉醇(10 mg/只)、卡铂(40 mg/只),42 ℃腹腔灌注30 min.主要疗效指标为生存期,次要疗效指标为体质量、生化指标及安全性.结果模型制作成功率100%(42/42).空白组动物生存期18～30 d(中位数24 d);单纯CRS组20～40 d(中位数27 d);CRS+HIPEC组23～55 d(中位数46 d)(单纯CRS组比空白组比较,P＞0.05;CRS+HIPEC组比单纯CRS组,P＜0.01).与CRS组比较,HIPEC至少能使生存期延长70%.体质量变化趋势提示HIPEC可延缓肿瘤所致的体质量减轻.各组动物种瘤前、术前及术后第8天外周血细胞计数及血生化指标差异无统计学意义(P＞0.05).结论对胃癌PC大动物模型,CRS不能改善预后,而CRS+HIPEC能显著延长生存期,安全可行.
목적 관찰세포감멸술(CRS)가복강열관주화료(HIPEC)치료위암복막전이암(PC)적료효화안전성.방법 취성년웅성신서란대백토42지,장VX2암세포주입위두부점막하,제성궤양형위암PC모형,수궤분위공백조(n=14)、단순CRS조(n=14)、CRS+HIPEC조(n=14).충류후제8～9천행치료,HIPEC약물위다서자삼순(10 mg/지)、잡박(40 mg/지),42 ℃복강관주30 min.주요료효지표위생존기,차요료효지표위체질량、생화지표급안전성.결과 모형제작성공솔100%(42/42).공백조동물생존기18～30 d(중위수24 d);단순CRS조20～40 d(중위수27 d);CRS+HIPEC조23～55 d(중위수46 d)(단순CRS조비공백조비교,P＞0.05;CRS+HIPEC조비단순CRS조,P＜0.01).여CRS조비교,HIPEC지소능사생존기연장70%.체질량변화추세제시HIPEC가연완종류소치적체질량감경.각조동물충류전、술전급술후제8천외주혈세포계수급혈생화지표차이무통계학의의(P＞0.05).결론 대위암PC대동물모형,CRS불능개선예후,이CRS+HIPEC능현저연장생존기,안전가행.
Objective To study the efficacy and safety of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) to treat rabbit model of gastric cancer with peritoneal carcinomatosis (PC).Methods VX2 tumor cells were injected into the gastric submucosa of 42 adult male New Zealand rabbits using a laparotomic implantation technique,to construct rabbit model of gastric cancer with PC.The rabbits were randomly divided into three groups:control group (n = 14),CRS group (n = 14),and CRS + HIPEC group (n = 14 ).The rabbits in control group were observed for natural course of disease progression.Treatments were initiated 8 or 9 days after inoculation of tumor cells,including optimal removal of tumor nodules in CRS group,and maximal removal of tumor nodules and heperthermic chemoperfusion in the CRS + HIPEC group with docetaxel (10 mg/rabbit ) and carboplatin (40 mg/rabbit) at 42 ℃ for 30 min.The primary endpoint was overall survival.The secondary endpoints were body weight,biochemistry,major organ functions and serious adverse events.Results The success rates of rabbit PC model were 100% (42/42).The clinicopathological feature of the model was similar to peritoneal carcinomatosis in human.Overall survival was 18-30 days ( median 24 days) in control group,20-40 days ( median 27 days) in CRS group,and 23-55 days ( median 46 days) in CRS plus HIPEC group ( CRS alone group VS control group,P ＞ 0.05;CRS + HIPEC group vs pure CRS group,P ＜ 0.01 ).As compared with CRS only or control groups,HIPEC could extend the overall survival by at least 70%.At the baseline,on the day of surgery and 7 days after surgery,the count of peripheral blood cells,liver and renal functions,and biochemistry parameters were all comparable.Serious adverse events occurred in 0 animal in control group,2 animals in CRS group including 1 animal died of anesthesia overdose and another 1died of postoperative hemorrhage,and 3 animals in CRS + HIPEC group including 1 animal died of anesthesia overdose,and 2 died of diarrhea 23 and 27 days after operation.Conclusion For rabbit model of gastric cancer PC,CRS alone could not bring benefit while CPS + HIPEC with docetaxel and cisplatin could significantly prolong the survival with a acceptable safety.