邬恒淼　董哲斌　何奕成　梁超

[关键词] 腹腔镜胃癌根治术;雷替曲塞;腹腔灌注化疗;安全性

[中图分类号] R735.2          [文献标识码] B          [文章编号] 1673-9701（2021）17-0053-04

Research on the safety of intraperitoneal perfusion chemotherapy with raltitrexed in laparoscopic radical gastrectomy for gastric cancer

WU Hengmiao   DONG Zhebin   HE Yicheng   LIANG Chao

Department of Gastrointestinal Surgery， Lihuili Hospital Affiliated to Ningbo University， Ningbo   315040， China

[Abstract] Objective To evaluate the safety index and adverse reactions （ARs） of intraperitoneal perfusion chemotherapy with raltitrexed in laparoscopic radical gastrectomy for gastric cancer. Methods A total of 62 patients with advanced gastric cancer undergoing laparoscopic radical gastrectomy for gastric cancer admitted to our hospital from May 2018 to May 2019 were selected. They were randomLy divided into the control group（n=31） and the observation group（n=31）.Patients in the control group were treated with conventional laparoscopic radical gastrectomy for gastric cancer， while those in the observation group were treated with intraperitoneal perfusion chemotherapy with raltitrexed based on the conventional laparoscopic radical gastrectomy for gastric cancer. The related toxicity indices and ARs of patients in the two groups were observed and evaluated. Results The preoperative and postoperative blood routine indices， including white blood cell count （WBC）， platelet count （PLT） and red blood cell count （RBC）， and hepatic and renal function indices， including serum creatinine （Cr）， blood urea （BUN）， alanine aminotransferase （ALT），aspartate aminotransferase （AST） between the two groups of patients were compared， without statistically significant differences（P>0.05）. The incidence of ARs in the observation group and the control group were 32.26% and 38.71%， respectively， without statistically significant differences between the two groups of data（P>0.05）. Conclusion Intraoperative intraperitoneal perfusion chemotherapy with raltitrexed in patients with advanced gastric cancer is relatively safe and reliable and does not increase the related toxicity indices and ARs of patients.

[Key words] Laparoscopic radical gastrectomy for gastric cancer; Raltitrexed; Intraperitoneal perfusion chemotherapy; Safety

胃癌是世界上五大常见的恶性肿瘤之一，同时也是三大导致癌症死亡的主要原因之一[1]。中国大部分地区居民由于早期症状不明显且缺乏早期筛查意识，许多胃肠道肿瘤初诊时已为进展期，即使实行根治性手术，多数患者也会在2年左右出现局部复发[2-3]。氟尿嘧啶联合铂类药物的细胞毒性化学疗法是局部晚期胃癌的标准一线治疗方法，并根据是否存在人表皮生長因子受体-2（Human epidermal growth factor receptor-2，HER2）的表达，判断是否联合使用曲妥珠单抗，但是5年生存率仍然很差[4-6]。目前根治性手术已被认为是治疗胃癌的最佳选择，临床上往往通过术中腹腔灌洗干预的方式，消除术后残余游离癌细胞及微小癌灶，从而减少胃癌的局部复发。雷替曲塞（Raltitrexed）是水溶性胸苷酸合成酶（Thymidylate synthase，TS）的特异性抑制剂，具有抗肿瘤的作用，能够延长胃癌患者的无进展生存期和总体生存率[7]。本文选取我院62例胃癌患者，分析胃癌根治术中使用雷替曲塞腹腔灌注化疗的安全性，现报道如下。

1 资料与方法

1.1 一般资料

本研究内容及方案经宁波市医疗中心李惠利医院医学伦理委员会审批并备案。选取我院2018年5月至2019年5月间62例行腹腔镜远端胃癌根治术的患者，所有患者均知情并于术前签署知情同意书。纳入标准：①年龄18～80岁;②术前胃镜检查为Borrmann分型Ⅱ～Ⅲ型;③病灶口侧距贲门>10 cm;④病理诊断为胃腺癌（中-低分化）;⑤CT分期为cT3～4N0～1M0（Ⅱb～Ⅲa期）。排除标……