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进展期大肠癌术后早期腹腔灌洗化疗
了解进展期大肠癌术后早期腹腔灌洗化疗对防治腹腔内复发和肝脏转移的价值。方法 选择1990年～1997年经手术及病理证实的102例侵及浆膜或腹腔癌胚抗原增高的大肠癌，随机分成腹腔灌洗化疗组54例，静脉化疗组48例。腹腔灌洗化疗组于手术当日开始用43～45℃的双蒸馏水1 500～2 000ml加5-Fu 1g、MMC 10mg行腹腔灌洗，连续应用6次；静脉化疗组用5-Fu 1g、MMC 8 mg每日静滴1次，连续6次；两组各用6次后改为口服呋喃氟脲嘧啶，总量为40 g。结果 静脉化疗组腹腔内复发12例，肝脏转移6例；腹腔灌洗化疗组腹腔内复发2例，肝脏转移2例。两组未见并发症。结论 术后早期腹腔灌洗化疗对防治进展期大肠癌腹腔内复发和肝脏转移有明显疗效，而且方法简单，安全、实用。
Early postoperative intraperitoneal perfusion chemotherapy for advanced colorectal cancer Sun Nianxu, Cai Zhimin, Zhang Chao, Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038
【Abstract】 Objective To study the effect of early postoperative intraperitoneal perfusion chemotherapy (IPPC) on the prevention of peritoneal recurrence and liver metastasis in patients with advanced colorectal cancer.Methods From 1990 through 1997, 102 patients with advanced colorectal cancer were admitted. The tumor invaded the intestinal serosa with elevated CEA in the peritoneal fluid. Fifty-four of the 102 patients, beginning from the operation day, were given IPPC, once per day for 6 days, with warm(43～45℃) sterile double distilled water containing 1 g 5-Fu and 10 mg MMC. The other 48 patients, as control, received 1 g 5-Fu and 8 mg MMC by iv infusion, once per day for 6 days. In addition, oral tegafur was given to all patients with a total dose of 40 g.Results In patients treated with IPPC, peritoneal recurrence developed in 2 patients, liver metastasis in 2 patients whereas 12 cases had peritoneal recurrence and 6 had liver metastasis in patients treated by iv infusion. No complication developed in any of the treated patients.Conclusion IPPC is effective in preventing tumor recurrence in the peritoneal cavity and metastasis to the liver in patients with advanced colorectal cancer. The treatment procedure is simple and safe.
【Subject words】 Colonic neoplasms/surgry Colonic neoplasms/drug therapy Rectal neoplasms/surgryRectal neoplasms/drug therapy Intraperitoneal chemotherapy
大肠癌在我国以中晚期居多，虽然经以手术为主的综合治疗，却仍有半数治疗失败。其主要原因是中晚期大肠癌容易侵犯浆膜，使癌细胞脱落到腹腔；或者手术时癌肿被挤压，离断肠管、血管、淋巴管时癌细胞或癌栓脱落到腹腔，导致术后腹腔内复发。因此，早期清除或杀灭脱落于腹腔的癌细胞或癌栓，是防止腹腔内复发的关键。我院自1990年开始应用术后早期腹腔内灌洗化疗防治进展期大肠癌腹腔内复发，取得了满意的效果，现将结果报告如下。
