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肿瘤细胞减灭术加腹腔热灌注化疗治疗阑尾腺癌腹膜癌的临床研究
作者:李鑫宝  姬忠贺  于洋  张彦斌  刘刚  李兵  张凯  李雁 
单位:首都医科大学附属北京世纪坛医院腹膜肿瘤外科  北京 100038 
关键词:阑尾肿瘤/治疗 腹膜肿瘤/治疗 腺癌/治疗 手术后期间 高温 诱发 化学疗法 肿瘤 局部灌注 综合疗法 存活率 回顾性研究 
DOI:10.13267/j.cnki.syzlzz.2019.01.014
出版年,卷(期):页码:2019,34(1):66-71
摘要:

目的 评估肿瘤细胞减灭术(cytoreductive surgery,CRS)+腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)治疗阑尾腺癌腹膜癌的疗效及安全性。方法 分析接受CRS+HIPEC治疗的42例阑尾腺癌腹膜癌患者临床数据,研究指标为生存期、围手术期安全性及不良事件。结果 42例阑尾腺癌腹膜癌患者腹膜癌指数(peritoneal cancer index,PCI)1~39分,中位31分;肿瘤减灭程度(completeness of cytoreduction,CC)0~3分,中位2分。随访时间1~61个月(中位18.3个月),18例(42.9%)死亡,24例(57.1%)生存,中位生存时间为40.0个月(95% CI:32.2~47.8个月),1、3和5年生存率分别为75.3%、52.8%和29.7%。CC ≤ 1分和CC>1分的患者中位生存时间分别为46.0和34.0个月(P=0.033)。有和没有严重不良事件的患者中位生存时间分别为41.0和2.0个月(P=0.002)。围手术期不良事件发生率为14.3%,切口感染裂开1例,肠吻合口瘘4例,急性心肌梗死1例。结论 CRS+HIPEC治疗阑尾腺癌腹膜癌可行有效。

Objective To evaluate the efficacy and safety of cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) on patients with peritoneal carcinomatosis (PC) from appendiceal adenocarcinoma. Methods The clinical data of 42 cases of patients with PC from appendiceal adenocarcinoma who were treated with CRS+HIPEC was analyzed.The study indices included survival length,perioperative safety and adverse effects. Results The peritoneal cancer index (PCI) ranged from 1 to 39 in the 42 patients with PC from appendiceal adenocarcinoma,with a median score of 31.The completeness of cytoreduction (CC) ranged from 0 to 3,and the median was 2. Followed up for 1 to 61 months (median=18.3 months),18 patients (42.9%) died and 24 patients (57.1%) survived. The median overall survival time was 40.0 months (95%CI:32.2-47.8 months),and the 1-,3-and 5-year survival rates were 75.3%,52.8%,and 29.7%,respectively.Moreover,the median survival times of patients with CC ≤ 1 and CC >1 were 46.0 months and 34.0 months,respectively (P=0.033),and the median survival times of patients with and without serious adverse event were 41.0 months and 2.0 months,respectively (P=0.002).Finally,the incidence of perioperative adverse events was 14.3%,with one case of abdominal incision infection,4 cases of intestinal anastomosis fistula,and one case of acute myocardial infarction. Conclusion CRS + HIPEC showed good safety and clinical efficacy in the treatment of PC from appendiceal adenocarcinoma.

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