·18·实用临床医药专志2o12年第16卷第13期JournalofCIinicalMedicineinPractice⋯。⋯‘⋯雷替曲塞等化疗药物低剂量动脉灌注治疗胃癌术后并发恶性肠梗阻王咏梅，王革芳，吴成利，姜程远，陆海洲，徐蕾，周善黎(解放军第85医院肿瘤科，上海，200052)摘要：目的探讨雷替曲塞等小剂量化疗药物介人性动脉灌注对胃癌术后腹腔转移致恶性肠梗阻的疗效。方法42例胃癌术后伴不完全性肠梗阻患者，经肠系膜上动脉或加腹腔动脉、肠系膜下动脉等插管，灌注低剂量化疗药物，药物用量为雷替曲塞2mg，奥沙利伯5O～100mg，多西他赛20-40nag，化疗周期为每3～4周动脉灌注1次。本组病例至少灌注1次，最多7次。对照组42例给予内科姑息治疗，未给予化疗药物。结果介人化疗后肠梗阻缓解有效率为80．95％(34／42例)；对照组肠梗阻缓解有效率为42．85％(18／42例)，两组相比差异显著(P<0．01)。介入化疗组排气、排便及腹痛腹胀的缓解时间均短于对照组，肠道通畅总维持时间长于对照组，两组相比统计学差异均显著。介人化疗组生存时间为2～36个月，中位生存时间5个月；对照组平均生存期为(2．69±2．25)个月，中位生存时间为3个月，两组生存时间统计学差异非常显著(P<0．01)。介入治疗组对腹水治疗的总有效率为76．0(19／25)，也高于对照组(P<0．01)。介入治疗组治疗后KPS评分提高，ECOO评分下降。结论小剂量化疗药物动脉灌注对胃癌术后腹腔转移致肠梗阻副作用小，能在短期内明显缓解癌性肠梗阻症状，肠道通畅维持时间长，并能有效控制伴随的腹水症状，延长生存时间，提高生活质量，尤其适用于老年及体质虚弱者。关键词：胃癌；恶性肠梗阻；动脉灌注化疗；雷替曲塞中图分类号：R735．2文献标志码：A文章编号：1672—2353(2012)l3—0018—05ArterialinfusionchemotherapywithlowdosageofraltitrexedforpostoperativemalignantbowelobstructioninpatientswithgastriccancerWANGYong—mei，WANGGe—fang，WUCheng—li，JIANGCheng—yuan，LUHai—zhou，XULei，ZHOUShan—li(Th85thHospita￡ofthPPeoplgsLiberati0Army，Shanghai，200052)ABSTRACT：0bjectiveToevaluatetheefficacyofarterialinfusionchemotherapywithlowdosageofraltitrexedinthetreatmentofpostoperativemalignantbowelobstructioninpatientswithgastriccancer．MethodsForty—twogastriccancerpatientswithincompletepostoperativebowelobstructionwereincludedinthetreatmentgroup．Thetreatmentgroupreceivedarterialinfusionchemotherapybysuperiormesentericarteryandcoeliacartery，orinferiormesentericartery：raltitrexed，2mg，oxaliplatin，50—100mg，docetaxel，20—40mg，onceevery3—4weeks．Everypatientwasgivenarterialinfusionchemotherapyminimumonce，maximum7times．The42pa—tientsinthecontrolgroupreceivedapalliativemedicinetreatmentwithoutchemotherapy．ResultsTheremissionrateofbowelobstructionwas80．95％(34／42)inthetreatmentgroupand42．85％(18／42)inthecontrolgroup．Thedifferenceofthetwogroupswasstatisticallysignificant(P<0．01)．Therelieftimeofflatulence，defecate，abdomina1painandabdominaldistensioninthetreat-mentgroupwasshorterthaninthecontrolgroup．Thedifferencewasstatisticallysignificant．Thesurvivaltimeofthetreatmentgrouprangedfrom2to36monthswithamediansurvivaltimeof,5months．Thesurvivaltimeofthecontrolgrouprangedwas2．69±2．253monthswithamediansur-vivaltimeof3months．Thedifferenceofsurvivaltimeofthetwogroupswerestatisticallysignifi—cant(P<0．01)．TheKPSscoreimprovedandECOGscoredecreasedinthetreatmentgroupafter收稿日期：2012—05—2O第13期王咏梅等：雷替曲塞等化疗药物低剂量动脉灌注治疗胃癌术后并发恶性肠梗阻·l9·treatment．ConclusionThearterialinfusionchemotherapywithlowdosageofraltitrexediseffectiveandsafeinthetreatmentofmalignantbowdobstructioninpatientswithgastriccancerafteroperation．Itcaneasesymptomsofbowe...
