【摘要】：背景在我國,絕大多數(shù)胃癌患者被確診時(shí)已為進(jìn)展期,即使行根治性切除手術(shù),術(shù)后仍有多數(shù)患者因腹腔脫落癌細(xì)胞造成局部復(fù)發(fā)或遠(yuǎn)處轉(zhuǎn)移,預(yù)后較差。因此,如何有效清除腹腔脫落癌細(xì)胞和殘留微小癌灶進(jìn)而防治腫瘤在腹腔內(nèi)復(fù)發(fā)及轉(zhuǎn)移是影響胃癌患者術(shù)后生存率的關(guān)鍵因素。為了防治胃癌術(shù)后腹腔復(fù)發(fā)或轉(zhuǎn)移,改善進(jìn)展期胃癌患者的預(yù)后,我院對進(jìn)展期胃癌患者進(jìn)行根治性切除術(shù)聯(lián)合術(shù)中精準(zhǔn)腹腔熱灌注治療、術(shù)后全身靜脈化療的綜合治療方案,探討其安全性及臨床療效有利于推動(dòng)此項(xiàng)治療技術(shù)健康發(fā)展,促進(jìn)此項(xiàng)技術(shù)的臨床應(yīng)用,使更多的胃癌患者受益。目的觀察術(shù)中精準(zhǔn)腹腔熱灌注治療聯(lián)合術(shù)后全身靜脈化療與術(shù)后常規(guī)靜脈化療治療進(jìn)展期胃癌患者的效果差異,探討術(shù)中精準(zhǔn)腹腔熱灌注治療的安全性及有效性。方法選擇南陽市中心醫(yī)院普通外科自2012年03月至2013年02月收治的接受D2根治術(shù)的進(jìn)展期胃癌患者96例(經(jīng)病理證實(shí)),按照治療方法的不同分為術(shù)中行精準(zhǔn)腹腔熱灌注治療者47例(研究組),術(shù)中僅行常規(guī)腹腔沖洗者49例(對照組),兩組患者均于術(shù)后3-4周按照mFOLFOX6方案行全身靜脈化療,分析兩組臨床資料,比較兩組患者術(shù)后不良反應(yīng)發(fā)生率、生存質(zhì)量、并發(fā)癥發(fā)生率、3年腫瘤局部復(fù)發(fā)率、遠(yuǎn)處轉(zhuǎn)移率及生存率。其中不良反應(yīng)包括兩組患者術(shù)后未接受靜脈化療前的血常規(guī)、肝功能等血液指標(biāo)及體溫、血壓等臨床觀察指標(biāo)的異常和接受靜脈化療后出現(xiàn)的骨髓抑制、胃腸道反應(yīng)等毒性反應(yīng),生存質(zhì)量評估參考KPS評分標(biāo)準(zhǔn),并發(fā)癥包括吻合口瘺、切口感染、腹腔感染、肺部感染、腸梗阻。結(jié)果比較兩組患者術(shù)后各種不良反應(yīng)發(fā)生率,數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)處理,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。比較兩組患者術(shù)后生存質(zhì)量評分,研究組的總有效率為80.9%,高于對照組的61.2%,數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)處理,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。研究組術(shù)后吻合口瘺、切口感染、腹腔感染、肺部感染發(fā)生率分別為4.3%、4.3%、6.4%、8.5%,低于對照組的8.2%、6.1%、8.2%、12.2%,數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)處理,差異均無統(tǒng)計(jì)學(xué)意義(均P0.05);研究組患者術(shù)后腸梗阻發(fā)生率為12.8%,低于對照組的30.6%,數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)處理,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。研究組患者術(shù)后3年腫瘤局部復(fù)發(fā)率、遠(yuǎn)處轉(zhuǎn)移率分別為10.6%和12.8%,低于對照組的28.6%和34.7%,研究組患者術(shù)后3年生存率為68.1%,高于對照組的46.9%,數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)處理,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.進(jìn)展期胃癌患者行D2根治術(shù)后于術(shù)中行精準(zhǔn)腹腔熱灌注治療聯(lián)合術(shù)后全身靜脈化療較術(shù)后單純行全身靜脈化療能顯著提高患者術(shù)后的生存質(zhì)量。2.術(shù)中精準(zhǔn)腹腔熱灌注治療安全可行,可降低進(jìn)展期胃癌患者術(shù)后腸梗阻并發(fā)癥發(fā)生率,不增加患者的不良反應(yīng)發(fā)生率及術(shù)后吻合口瘺、切口感染、腹腔感染、肺部感染并發(fā)癥的發(fā)生率。3.術(shù)中精準(zhǔn)腹腔熱灌注治療聯(lián)合術(shù)后全身靜脈化療可提高進(jìn)展期胃癌患者術(shù)后3年生存率,降低術(shù)后3年腫瘤局部復(fù)發(fā)率和遠(yuǎn)處轉(zhuǎn)移率,可有效防治進(jìn)展期胃癌患者術(shù)后腹腔復(fù)發(fā)和遠(yuǎn)處轉(zhuǎn)移。
[Abstract]:Background in our country, most of the patients with gastric cancer have been diagnosed as progressing stage. Even after radical resection, the prognosis is poor in most patients with local recurrence or distant metastasis caused by abdominal abscission of cancer cells in the abdominal cavity. Therefore, how to effectively remove the peritoneal Exfoliative and residual cancer cells and prevent the tumor recurrence in the abdominal cavity And metastasis is the key factor affecting the postoperative survival rate of gastric cancer patients. In order to prevent the recurrence or metastasis of the abdominal cavity after the operation and improve the prognosis of the patients with advanced gastric cancer, our hospital carries out radical excision combined with accurate peritoneal heat infusion in the treatment of advanced gastric cancer, and the comprehensive treatment of postoperative whole body vein chemotherapy, and discuss the safety of the patients with advanced gastric cancer. The effect of sex and clinical effect can promote the healthy development of this treatment technology, promote the clinical application of this technique and make more patients with gastric cancer benefit. Objective To observe the difference of the effect of intraoperative precision peritoneal perfusion therapy combined with general venous chemotherapy and postoperative routine intravenous chemotherapy in the treatment of advanced gastric cancer patients after operation, and to explore the precise abdominal cavity in the operation. The safety and effectiveness of hot perfusion therapy. Methods 96 patients with advanced gastric cancer treated with D2 radical operation from 03 months to 02 months of 2013 from 2012 to 02 months in Nanyang Central Hospital were selected and 47 cases (Study Group) were treated with different treatment methods. 49 cases (control group), the two groups were treated with mFOLFOX6 regimen 3-4 weeks after the operation. The two groups of clinical data were analyzed. The incidence of adverse reactions, the quality of life, the incidence of complications, the local recurrence rate of the 3 year tumor, the distant metastasis rate and the survival rate were compared in the two groups, among which the adverse reactions included two groups of patients. The blood routine before intravenous chemotherapy, liver function and other blood indexes, abnormal clinical observation of body temperature, blood pressure and other toxic reactions such as myelosuppression and gastrointestinal reaction after intravenous chemotherapy, and quality of life assessment reference KPS score standard, complications including anastomotic fistula, incision infection, abdominal infection, lung infection, intestine The incidence of all adverse reactions after operation was compared between the two groups. The difference was not statistically significant (P0.05). The total effective rate of the two groups was 80.9%, higher than that of the control group (61.2%). The data were statistically treated with statistical significance (P0.05). The incidence of stoma fistula, incision infection, abdominal infection, and pulmonary infection were 4.3%, 4.3%, 6.4%, 8.5% respectively, which were 8.2%, 6.1%, 8.2%, 12.2% of the control group. The difference was not statistically significant (all P0.05). The incidence of intestinal obstruction after operation was 12.8% in the study group of 12.8%, lower than 30.6% in the control group, and the data were statistically treated with statistical differences. P0.05. The local recurrence rate of tumor in the 3 years after operation was 10.6% and 12.8%, respectively, 28.6% and 34.7% in the study group. The 3 year survival rate of the patients in the study group was 68.1%, higher than that of the control group (46.9%). The data were statistically significant (P0.05). Conclusion 1. advanced gastric cancer patients were treated with D2 It is safe and feasible to improve the quality of survival after the combined total venous chemotherapy after the combined operation of the combined total intravenous chemotherapy after the operation of the combined total intravenous chemotherapy compared with the total systemic venous chemotherapy after the operation. It can reduce the incidence of postoperative intestinal obstruction complications in the patients with advanced gastric cancer, and does not increase the adverse reaction of the patients with.2.. The incidence and postoperative anastomotic fistula, incision infection, abdominal infection, and the incidence of complications of pulmonary infection,.3. intraoperative intraperitoneal hyperthermic perfusion therapy combined with postoperative systemic venous chemotherapy can improve the 3 year survival rate of patients with advanced gastric cancer, reduce local recurrence rate and distant metastasis rate of 3 years after operation, and can effectively prevent and cure advanced gastric cancer patients. The intraperitoneal recurrence and distant metastasis were observed after operation.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 安繼榮;劉小輝;成建榮;;參芪扶正注射液配合胃癌術(shù)后輔助化療臨床觀察[J];西部中醫(yī)藥;2015年08期

2 宋展;錢國武;呂柯;張海洋;王新偉;孫曉林;王耿澤;趙玉亭;僧國珍;;局部進(jìn)展期胃癌術(shù)中腹腔熱灌注化療的療效評價(jià)[J];中華普通外科雜志;2015年06期

3 李雁;周云峰;梁寒;王華慶;郝繼輝;朱正綱;萬德森;欽倫秀;崔書中;季加孚;徐惠綿;魏少忠;許洪斌;鎖濤;楊樹軍;謝叢華;楊肖軍;楊國j;;細(xì)胞減滅術(shù)加腹腔熱灌注化療治療腹膜表面腫瘤的專家共識[J];中國腫瘤臨床;2015年04期

4 董保國;謝桂生;王佳雷;;進(jìn)展期胃癌術(shù)中腹腔熱灌注化療的效果分析[J];中國現(xiàn)代普通外科進(jìn)展;2014年03期

5 張國勝;;圍手術(shù)期腹腔熱灌注對進(jìn)展期胃癌的療效分析[J];中國現(xiàn)代普通外科進(jìn)展;2013年11期

6 李濤;吳祥成;吳非常;凌華晃;莫奉山;蘇炳光;;多西他賽聯(lián)合腹腔熱灌注順鉑治療卵巢癌腹腔積液18例[J];社區(qū)醫(yī)學(xué)雜志;2013年11期

7 崔書中;;腹腔熱灌注化療在胃癌治療中的應(yīng)用新進(jìn)展[J];消化腫瘤雜志(電子版);2012年04期

8 崔書中;王佳泓;張相良;;腫瘤細(xì)胞減滅術(shù)聯(lián)合腹腔熱灌注化療治療結(jié)直腸癌腹膜轉(zhuǎn)移癌[J];中國腫瘤臨床;2012年22期

9 黃一唯;徐海帆;盧鋒;鄭迪;;胃癌術(shù)后早期腹腔循環(huán)熱灌注化療的臨床應(yīng)用[J];吉林醫(yī)學(xué);2012年08期

10 李守淼;李保中;劉志強(qiáng);白東曉;管建云;王海學(xué);;胃癌術(shù)后早期奧沙利鉑腹腔熱灌注化療的臨床分析[J];中華胃腸外科雜志;2012年02期

，

本文編號：2149048