目的:探讨术中腹腔热灌注化疗(HIPEC)的对进展期胃癌患者预后的影响.方法:2004年10月至2007年10月收治的90例进展期胃癌患者行D2根治术后随机分为HIPEC(实验组)和单纯手术组(对照组),术后4周均予以FOLFOX4方案静脉化疗12个疗程.测定患者手术前后外周血中肝肾功能的变化,分析比较患者生存情况.结果:实验组术后7d的外周血白蛋白(32.34±2.23) g/L较术前(46.45±4.81) g/L显著下降(P＜0.05).实验组和对照组Ⅱb期患者5年生存率分别为66.7％和60.0％(P＞0.05),Ⅲ期患者5年生存率分别为45％和35.9％(P＞0.05),Ⅲa期患者5年生存率分别为63.6％和58.3％(P＞0.05),Ⅲb期患者5年生存率分别为40.9％和27.3％,中位生存期分别为51.0个月(95％CI:36.1 ～ 65.9个月)、20.0个月(95％CI:12.0 ～ 28.0个月),差异均有统计学意义(P＜0.05),Ⅲc期胃癌患者5年生存率分别为28.6％和20％ (P＞0.05).结论:术中HIPEC可提高Ⅲb期胃癌患者术后的5年生存率,延长生存期.%Objective: This work aims to determine the efficacy of intraoperative chemohyperthermic peritoneal perfusion (ICHPP) on the prognosis of patients with advanced gastric cancer of different stages. Methods: Ninety patients were divided into the treatment (Group A) and control groups (Group B), all of which underwent radical gastrectomy and D2 node dissection. The patients in Group A received ICHPP therapy after surgery, whereas those in Group B underwent a gastric carcinoma resection without ICHPP. Chemotherapy using a FOLFOX4 regimen, particularly, oxaliplatin, fluorouracil, and calcium leucovorin, was administered intravenously in both groups, four weeks after surgery. Systemic chemotherapy was administered for 12 cycles. Hepatorenal functions were determined in the patients with advanced gastric cancer before and after the surgery. The survival rates in both groups were observed and compared. Results: Peripheral blood albumin levels significantly decreased in Group A, 7 days after the treatment (32.34 g/L ± 2.23 g/L, 46.45 g/L ± 4.81 g/L; P＜0.05 vs. pre-operation), but were significantly lower compared with Group B (32.34 g/L ± 2.23 g/L, 41.45 g/L ± 5.25 g/L, PO.05 vs. Group B). For the stage ⅡB cases, the 5-year survival rate was 66.7% in Group A and 60% in Group B. No significant differences were observed between the two groups (P＞ 0.05). For the stage Ⅲ A cases, the 5-year survival rate was 63.6% in Group A and 58.3% in Group B. No significant differences were observed between the two groups (P＞0.05). For the stage Ⅲ B cases, the 5-year survival rate was 40.9% in Group A and 27.3% in Group B. The differences between the two groups were significant (P＜0.05). For the stage-Ⅲ C cases, the 5-year survival rate was 28.6% in Group A and 20% in Group B, without significant differences between the two groups (P＞0.05). Conclusion: Surgical resection combined with HIPEC may prolong survival of the patients with stage Ⅲb gastric carcinoma.
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