苗志国 罗志鹏 黄凯

[摘要] 目的 探讨进展期胃肠道肿瘤术中使用雷替曲塞腹腔灌注化疗的安全性和疗效。 方法 选择48例进展期胃肠道肿瘤患者随机分为A、B两组，B组采用常规开腹手术治疗，A组行常规开腹手术+术中雷替曲塞腹腔灌注治疗。比较两组患者血常规、肝肾功能的变化，观察术后并发症发生情况及胃肠道功能恢复时间及2年生存率。结果 两组术后白细胞计数、肝肾功能比较无统计学差异，术后两组腹腔引流时间、胃肠道功能恢复时间、并发症及不良反应发生率无统计学差异（P>0.05），A组术后1年及2年生存率高于B组（P<0.05）。 结论 进展期胃肠道肿瘤术中雷替曲塞腹腔灌注化疗安全有效，联合术后辅助化疗可提高患者的2年生存率。

[关键词] 胃肠道肿瘤；雷替曲塞；腹腔化疗；安全性

[中图分类号] R735 [文献标识码] A [文章编号] 1673-9701（2018）25-0010-03

[Abstract] Objective To investigate the safety and efficacy of intraperitoneal perfusion chemotherapy with raltitrexed in the surgery of advanced gastrointestinal cancer. Methods 48 patients with advanced gastrointestinal tumors who were selected and divided into two groups. group B was given routine open surgery， and group A was given routine open surgery+intraoperative intraperitoneal perfusion of raltitrexed. The changes of blood routine test， and liver and kidney function between two groups were compared. The postoperative complications， the recovery time of gastrointestinal function and two-year survival rate were observed. Results There was no statistically significant difference in white blood cell count and liver and kidney function between the two groups after surgery. There was no statistically significant difference in the time of abdominal drainage， recovery time of gastrointestinal function， complications and adverse reactions between the two groups（P>0.05）. The 1-year and 2-year survival rates in the group A were higher than those in the group B（P<0.05）. Conclusion Intraperitoneal perfusion chemotherapy with raltitrexed is safe and effective in the surgery of advanced gastrointestinal tumor. Combined postoperative adjuvant chemotherapy can improve the 2-year survival rate of patients.

[Key words] Gastrointestinal tumor； Raltitrexed； Intraperitoneal chemotherapy； Safety

在中國，许多胃肠道肿瘤初诊时已为进展期，即实行根治性手术，多数患者也会在2年左右出现局部复发[1-3]，究其原因，最常见的是术中肿瘤细胞脱落入腹腔，进而造成腹腔种植复发及转移，因此作为处理腹腔脱落肿瘤细胞的手段，腹腔灌注越来越受到临床的重视。雷替曲塞是胸苷酸合成酶（TS）的特异性抑制剂，通过细胞膜上的还原型叶酸盐转运载体主动摄取至细胞内，代谢成多种聚合谷氨酸，特异性抑制TS，起到长效抗肿瘤的作用。本文回顾分析2016年1～4月间，江西省肿瘤医院腹外二科收治的48例胃肠癌患者，术中进行雷替曲塞腹腔灌注化疗，现报道如下。

1 资料与方法

1.1 一般资料

全部病例为江西省肿瘤医院腹外二科2016年1～4月收治的48例胃肠肿瘤患者，所有病例术前均经病理检查确诊，术前CT或磁共振影像资料评估为进展期，其中胃癌24例，结肠癌13例，直肠癌11例；全……