区域动脉灌注化疗与全身静脉化疗治疗进展期原发性胃癌的效果(1)

http://www.100md.com 2016年11月15日 《中国医药导报》 2016年第32期

     [摘要] 目的 探讨区域动脉灌注化疗与全身静脉化疗在进展期原发性胃癌患者中的应用效果。 方法 选取河北北方学院附属第一医院2011年1月～2014年12月收治的进展期胃癌患者120例，按随机数字表法将其分为区域动脉灌注化疗组和全身静脉化疗组，每组60例。均行1个周期EOF新辅助化疗方案(奥沙利铂+表柔比星+氟尿嘧啶)治疗，观察记录两组临床疗效、不良反应、术后并发症等。 结果 区域动脉灌注化疗组疗效满意率为63.33%，明显高于全身静脉化疗组的43.33%，差异有统计学意义(χ2=5.304，P=0.008)；两组患者不良反应均集中在0～2级，区域动脉灌注化疗组各类不良反应发生率均显著低于全身静脉化疗组(P < 0.01)。区域动脉灌注化疗组术后并发症发生率显著低于全身静脉化疗组(P < 0.05)。治疗前两组Survivin蛋白表达水平比较，差异无统计学意义( P> 0.05)；治疗后区域动脉灌注化疗组Survivin蛋白表达水平显著低于全身静脉化疗组(P < 0.05)。化疗方式为影响胃癌患者新辅助治疗后疗效满意率的独立影响因素。 结论 区域动脉灌注化疗可提高进展期原发性胃癌的疗效，具有不良反应小，并发症少的特点，值得临床推广。

    [关键词] 新辅助化疗；胃癌；区域动脉灌注；全身静脉化疗

    [中图分类号] R735.2 [文献标识码] A [文章编号] 1673-7210(2016)11(b)-0113-04

    [Abstract] Objective To investigate the application effect of regional arterial infusion chemotherapy and systemic vein chemotherapy in treatment for advanced primary gastric carcinoma. Methods 120 patients with advanced primary gastric carcinoma received EOF neoadjuvant chemotherapy (Oxaliplatin，Epirubicin，and FU) in the First Hospital Affiliated to Hebei North University from January 2011 to December 2014 were randomly divided into regional arterial infusion chemotherapy group (RAIC group) and systemic vein chemotherapy group (SVC group)， 60 cases in each group. The curative effect， adverse reaction and postoperative complications of two groups were determined. Results The overall satisfactory rate of RAIC group and SVC group were 63.33% and 43.33%， respectively， with significant difference (χ2=5.304，P=0.008). The adverse effect of two groups were 0 to 2 class. All kinds of adverse effect of RAIC group were significantly lower than that of SVC group (P < 0.01)， the same as postoperative complications (P<0.05). No significant difference were found between Survivin expression level of two groups before treatment. And it was significantly lower than that of SVC group after treatment (P<0.05). Chemotherapy method was independent influencing factor of curative effect of advanced primary gastric carcinoma. Conclusion Treatment on advanced primary gastric carcinoma with regional arterial infusion chemotherapy showed specific curative effect， with low toxic and side effect and complications. Regional arterial infusion chemotherapy deserves the clinical expansion.

    [Key words] Neoadjuvant chemotherapy； Gastric carcinoma； Regional arterial infusion； Systemic vein chemotherapy

    胃癌是臨床最常见的消化道肿瘤，由于早期诊断率低，患者多为进展期，手术切除率低，预后不良[1]。然而，患者被确诊时多已为进展期，早期诊断率不足10%[2]。新辅助化疗在进展期胃癌患者的治疗中因获得了循证医学方面的证据，被国内外临床治疗指南推荐作为标准治疗，以其独特的优点受到越来越多临床医生的关注和青睐[3-4]。国内外大量研究显示，新辅助化疗可能会提高术后完全缓解率，如全身静脉化疗、区域动脉介入化疗和腹腔灌注化疗等，但缺乏统一的标准方案。目前，如何通过新辅助化疗提高进展期胃癌患者的病理缓解率是研究热点之一。(胡晓峰 武雪亮 李磊 聂双发 郭飞 )

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