目的：观察胃癌根治术后腹腔热灌注化疗联合奥沙利铂（OXA）＋卡培他滨（Xeloda）（XELOX方案）辅助化疗的临床疗效与安全性。方法2011年1月—2012年3月收治胃癌术后患者112例，按术后治疗方法分为观察组（54例）和对照组（58例），观察组术后给予腹腔热灌注化疗（顺铂＋5－氟尿嘧啶）2～3次，2周后予XELOX 4周期化疗方案；对照组术后仅予XELOX 4周期化疗方案。比较2组化疗期间药物毒性反应，化疗结束后30 d采血检测肿瘤标志物[癌胚抗原（CEA）、糖蛋白抗原19-9（CA19-9）]水平，随访观察患者复发率、转移率与3年生存率。结果观察组化疗后30 d CEA水平为（4÷．2±2．0）μg／L，CA19-9水平为（19．7±6．5） U／ml，对照组分别为（7．1±3．1）μg／L、（37．4±15．1） U／ml，均显著低于治疗前（ P ＜0．01），且治疗后观察组水平明显低于对照组（ U ＝5．923、8．153， P ＜0．01）。观察组特异性毒性反应主要为腹膜刺激症状40例（18．5％），明显高于对照组的2例（3．4％）（χ2＝6．639， P ＝0．010），其余药物毒性反应发生率差异无统计学意义（ P ＞0．05）。观察组随访期内复发率为13．5％、远处转移率为19．3％，均低于对照组的32．1％、30．4％，其中复发率差异有统计学意义（χ2＝5．267， P ＝0．022）。观察组3年生存率为77．8％，明显高于对照组的58．6％（χ2＝4．705， P ＝0．030）。结论胃癌根治术后在行XELOX方案辅助化疗基础上，联合行腹腔热灌注化疗能进一步杀灭脱落癌细胞，降低肿瘤复发与远处转移率，延长远期生存时间，不良反应轻微可控。%Objective To observe the clinical efficacy and safety of the gastric cancer radical postoperative intraperi toneal hyperthermic perfusion chemotherapy combined with oxaliplatin (OXA) +capecitabine (Xeloda) (XELOX regimen) adjuvant chemotherapy .Methods From 2011 January to 2012 March, 112 cases gastric cancer patients were enrolled , ac-cording to the method of postoperative treatment , they were divided into observation group (54 cases) and control group (58 cases).Patients in the observation group were given chemotherapy of intraperitoneal hyperthermic perfusion chemotherapy (cisplatin +fluorouracil) 2-3 times, 2 weeks later were given XELOX for 4 cycles of chemotherapy;after surgery, in the control group , patients only received XELOX for 4 cycles of chemotherapy .Compared chemotherapy drug toxicity of the 2 group, after 30 days of chemotherapy , blood samples were collected to detect tumor marker [ carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA19-9)] level.All the patients were followed up to observe the recurrence rate , metas-tasis rate and 3 years survival rate .Results In the observation group after chemotherapy , after 30 days ’ CEA levels was (4.2 ±2.0)μg/L, CA19-9 level was (19.7 ±6.5) U /ml.The control group were (7.1 ±3.1)μg/L, (37.4 ±15.1) U/ml respectively, all were significantly lower than before treatment ( P <0.01), and observation group was significantly lower than that of the control group ( U =5.923, U =8.153, P <0.01).Observation group’s specific toxicity mainly was perito-neal irritation symptoms with 40 cases (18.5%), which was significantly higher than that of control group ’s 2 cases (3.4%) (χ2 =6.639, P =0.010), the rest of the drug toxicity showed no statistical significance differences ( P >0.05).Observa-tion group’s rate of recurrence during the follow-up period was 13.5%, metastasis rate was 19.3%, which were lower than the control group’s 32.1%and 30.4%.The difference of the recurrence rate was statistically significant (χ2 =5.267, P =0.022).The observation group’s 3 years survival rate was 77.8%, which was significantly higher than the control group ’s 58.6%(χ2 =4.705, P =0.030).Conclusion After radical gastrectomy for gastric cancer , combined with XELOX regimen adjuvant chemotherapy and intraperitoneal perfusion chemotherapy can further kill off cancer cells , reduce tumor recurrence and metastasis rate , prolong the long-term survival time , adverse reactions are mild and controllable .
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