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【摘要】目的探讨进展期胃癌术中腹腔内行区域性植入5�氟尿嘧啶缓释化疗的临床疗效及用药安全进行分析评价。方法将60例进展期胃癌患者均进行手术根治切除术后并随机分为两组，治疗组：30例患者给予术中行区域性缓释化疗；对照组30例患者与治疗组患者术后均进行常规全身化疗，并对其两组患者治疗后临床疗效进行疗效评价及安全性评价。结果疗效判定治疗组：完全缓解8例占26�7%、部分缓解11例占36�7%、疾病稳定7例占23�3%、疾病进展4例占13�3%。对照组：完全缓解5例占1�7%、部分缓解9例占30�0%、疾病稳定11例占36�7%、疾病进展5例占16�7%。两组患者在治疗后腹腔相关并发症与化疗毒副作用无显著差异。结论进展期胃癌术中腹腔内行区域性植入5�氟尿嘧啶缓释化疗，患者耐受性良好，用药后临床疗效增加而未见明显的全身、局部不良反应。
【关键词】进展期胃癌；区域缓释化疗；5�氟尿嘧啶缓释剂；疗效评价；不良反应
Advanced gastric cancer intraoperative regional safety evaluation of sustained�release chemotherapyHE Xing�chang.Departmetn of General Surgery The First People�s Hospital of Shangqiu city 476100,China
【Abstract】ObjectiveTo discuss advanced gastric cancer implanted in the abdominal cavity of regional experts 5�Fluorouracil chemotherapy efficacy and sustained�release drug safety analysis and evaluation�Methods60 cases of advanced gastric cancer patients underwent radical surgical resection were randomly divided into treatment groups:30 patients were treated with intraoperative regional slow�release chemotherapy,control group of 30 patients with treatment group patientsare routine chemotherapy, and two groups of patients after their clinical efficacy evaluation and safety evaluation�ResultsDetermine the efficacy of the treatment groups:complete remission in 8 cases accounted for 26�7%, partial response 11 cases accounted for 36�7%, seven cases of stable disease 23�3%, disease progression was four cases (13�3%)�Control group:5 cases were (1�7%) complete remission, partial remission in 9 cases accounted for 30�0%, stable disease 11 cases accounted for 36�7%, disease progression, five cases of 16�7%�Two groups of patients after abdominal�related complications in the treatment of chemotherapy side effects with no significant difference�ConclusionAdvanced gastric cancer surgery in the abdominal cavity implantation of regional experts 5�Fluorouracil sustained�release chemotherapy, the patient is well tolerated, clinical efficacy after treatment no significant increase in systemic and local adverse reactions.
【Key words】Advanced gastric cancer; Regional release chemotherapy; 5�Fluorouracil release agent; Evaluation; Adverse reactions
作者单位：476100河南省商丘市第一人民医院普外科胃癌仍属于人类主要癌症的死亡原因之一，胃癌的早期诊断至关重要，合理选择术式根治，疗效毋庸质疑，应予以肯定。进展期胃癌(AGC)又称晚期胃癌，在胃癌患者中AGC检出率为37％～39％；在可切除的Ⅰ～Ⅲ期患者中有半数以上术后复发转移进入晚期［1］。临床上进展期胃癌占大多数，治疗手段是以手术为主的综合治疗，即手术切除辅以化疗、放疗、免疫治疗等其他治疗，术中腹腔植入5�氟尿嘧啶缓释剂可以在给药区域形成较高的有效药物浓度，明显提高5�氟尿嘧啶杀灭处于快速增殖期的残留癌细胞机会。现对我院30例进展期胃癌患者术中行区域性缓释化疗并对其临床疗效及安全性评价，如下。
1资料与方法
1�1一般资料我院住院治疗的进展期胃癌60例，其中男38例，女22例；年龄41～76岁，平均56�4岁。肿瘤分期：Ⅰ期16例、Ⅱ期17例、Ⅲ期16例、Ⅳ期11例。病理分型：胃腺癌49例，贲门腺癌11例；术后证实区域淋巴结均有转移，术前检查无远处转移。临床常规分期检查包括临床体格检查、胃镜、胸部平片或CT、骨骼ECT、上腹部CT及全腹超声，所有患者心肝肾功能正常，术后无化疗禁忌证。
1�2方法将60例进展期胃癌患者均进行手术根治切除术后并随机分为两组，治疗组：30例患者给予术中行区域性缓释化疗；对照组30例患者与治疗组患者术后均进行常规全身化疗，并对其两组患者治疗后临床疗效进行疗效评价及安全性评价。
1�3治疗方法治疗组及对照组患者均根据肿瘤部位和侵犯程度行相应的标准根治性手术，包括远端胃癌根治术、近端胃癌根治术和全胃切除术。手术标准为肿瘤切缘无残留、淋巴结清扫至第2站淋巴结。治疗组术中根据肿瘤部位，将5�氟尿嘧啶缓释剂总量为800 mg植入肿瘤切除和淋巴结清扫区域。每一植药点植药不超过150 mg。为避免影响吻合口的愈合，要求植药点距吻合口≥2 cm。所有患者术后4周开始采用FOLFOX4化疗方案进行5个周期化疗。
1�4腹腔并发症、化疗毒副作用及疗效评定
1�4�1腹腔相关并发症的观察① 化学性腹膜炎，患者有腹膜刺激症状如明显腹痛，腹胀伴有腹肌紧张，发热和血白细胞升高等表现。②吻合口漏。③经细菌学证实的切口感染和/或裂开。④术后早期粘连性肠梗阻。⑤腹腔脓肿。⑥其他。
1�4�2化疗毒副作用指标① 严重的消化道反应，包括排除其他原因引起的不能忍受的恶心、反复呕吐、明显厌食等症状。②骨髓抑制，外周血白细胞(WBC)
