CAJ | 학술논문

目的:探讨术中腹腔热灌注化疗(CHPP)时进展期胃癌的疗效.方法:将60例进展期胃癌患者随机分为两组,常规行D2根治术,根据术中是否应用腹腔热灌注化疗,随机分为腹腔热灌注化疗组(治疗组)和单纯手术组(对照组),两组术后4周均予以FOLFOX4方案静脉全身化疗12个疗程.测定患者手术前后外周血中CEA和CA19-9含量的变化,观察并比较患者术后生存和肿瘤复发情况.结果:两组60例胃癌患者术前外周血CEA、CA19-9均值高于正常参考值上限(55.89±22.25μg/L vs0～5μg/L;125.35±61.78U/mL vs 0～39U/mL,P<0.01);且术前治疗组与对照组外周血CEA、CA19-9均值的差异无统计学意义(54.67±22.95μg/L vs 56.09±22.15μg/L;126.16±62.45U/mL vs 123.35±60.88U/mL,P>0.05).术后第7天,治疗组患者血清CEA、CA19-9下降显著(7.58±3.21μg/L,31.35±13.47 U/mL,P<0.01),对照组患者术后血清CEA和CA19-9下降缓慢(37.68±20.59μg/L,98.23±36.28U/mL,P>0.05).术后第30天,两组患者的血清CEA、CA19-9均较术前有显著性差异(P<0.05).治疗组与对照组术后1年生存率分别为83.3%和80.0%,两组差异无统计学意义(P>0.05),3年生存率分别为63.3%和40.0%,差异有统计学意义(P<0.05);治疗组与对照组术后1年肿瘤复发率分别为8.9%和12.1%,两组差异无统计学意义(P>0.05),3年复发率分别为21.6%和43.5%,两组差异有统计学意义(P<0.05).结论:手术联合CHPP能够显著降低进展期胃癌患者的外周血CEA和CA19-9的含量,术中CHPP有利于降低复发率和提高生存率.
목적:탐토술중복강열관주화료(CHPP)시진전기위암적료효.방법:장60례진전기위암환자수궤분위량조,상규행D2근치술,근거술중시부응용복강열관주화료,수궤분위복강열관주화료조(치료조)화단순수술조(대조조),량조술후4주균여이FOLFOX4방안정맥전신화료12개료정.측정환자수술전후외주혈중CEA화CA19-9함량적변화,관찰병비교환자술후생존화종류복발정황.결과:량조60례위암환자술전외주혈CEA、CA19-9균치고우정상삼고치상한(55.89±22.25μg/L vs0～5μg/L;125.35±61.78U/mL vs 0～39U/mL,P<0.01);차술전치료조여대조조외주혈CEA、CA19-9균치적차이무통계학의의(54.67±22.95μg/L vs 56.09±22.15μg/L;126.16±62.45U/mL vs 123.35±60.88U/mL,P>0.05).술후제7천,치료조환자혈청CEA、CA19-9하강현저(7.58±3.21μg/L,31.35±13.47 U/mL,P<0.01),대조조환자술후혈청CEA화CA19-9하강완만(37.68±20.59μg/L,98.23±36.28U/mL,P>0.05).술후제30천,량조환자적혈청CEA、CA19-9균교술전유현저성차이(P<0.05).치료조여대조조술후1년생존솔분별위83.3%화80.0%,량조차이무통계학의의(P>0.05),3년생존솔분별위63.3%화40.0%,차이유통계학의의(P<0.05);치료조여대조조술후1년종류복발솔분별위8.9%화12.1%,량조차이무통계학의의(P>0.05),3년복발솔분별위21.6%화43.5%,량조차이유통계학의의(P<0.05).결론:수술연합CHPP능구현저강저진전기위암환자적외주혈CEA화CA19-9적함량,술중CHPP유리우강저복발솔화제고생존솔.
Objective: To evaluate the efficacy of intraoperative hyperthermic peritoneal perfusion (CHPP) on advanced gastric carcinoma. Methods: Sixty patients with advanced gastric carcinoma were divided into the control group and the treatment group. All patients underwent radical gastrectomy and D2 node dissection. Patients in the treatment group received CHPP when surgical resection was completed. Patients in the control group underwent resection of gastric carcinoma without CHPP. Chemotherapy was administered with FOLFOX4 regimen intravenously for 12 cycles in both groups at 4 weeks after surgery. The serum Carcinoembryonic antigen (CEA) and CA19-9 were measured in patients with advanced gastric cancer before and after resection of tumor. Survival and recurrence in both groups were analyzed and compared. Results: The mean levels of the expression of CEA and CA19-9 in the peripheral blood of the 60 patients were significantly higher than the upper limits of normal (55.89±22.25μg/L vs 0～5μg/L; 125.35±61.78 U/mL vs 0～39U/mL P< 0.01). There were no significant differences in the mean levels of the expression of CEA and CA19-9 in the peripheral blood between the treatment group and the control group (54.67±22.95μg/L vs 56.09±22.15μg/L; 126.16±62.45 U/mL vs 123.35±60.88 U/mL,P>0.05). The serum CEA and CA19-9 levels were significantly decreased at 7 days after treatment in the treatment group (7.58±3.21 μg/L, 31.35±13.47 U/mL, P<0.01). The levels of these two tumor markers were decreased unremarkably at 7 days after treatment in the control group (37. 68±20.59μg/L, 98.23±36.28 U/mL, P>0.05). The serum CEA and CA19-9 levels were decreased significantly in both groups at 30 days after surgery (P<0.05). One-year survival and recurrence rates were 83.3% and 10% in the treatment group and 80% and 13.3% in the control group, with no significant differences between the two groups (P>0.05). Three-year survival and recurrence rates were 63.3% and 20% in the treatment group and 40% and 40% in the control group, with a significant difference between the two groups (P<0.05). Conclusion: Surgical resection combined with CHPP can significantly decrease the serum CEA and CA19-9 levels. Intraoperative CHPP for patients with advanced gastric carcinoma is helpful for preventing peritoneal metastasis and recurrence and can prolong survival time.