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目的探讨梗阻型结直肠癌患者术中及术后行门静脉灌注化疗联合术后FOLFOX4方案全身化疗对肿瘤肝脏转移的影响。方法收集2007年2月至2011年5月期间笔者所在医院可一期根治性切除的梗阻型结直肠癌患者94例,随机(信封法)分为2组,治疗组46例采取术中安置门静脉化疗泵同时行1次灌注化疗,术后3~4周行FOLFOX4方案全身化疗加门静脉泵灌注化疗6个疗程;对照组48例术后3~4周仅行FOLFOX4方案全身化疗6个疗程。化疗期间比较2组的毒副反应,并对94例患者随访3年观察其术后肿瘤肝脏转移的发生率。结果术后3年治疗组发生肿瘤肝脏转移10例(21.7%),对照组发生肿瘤肝脏转移28例(58.3%),后者明显高于前者(P<0.01)。2组临床毒副反应比较,治疗组术后第1天AST较对照组明显增高(P<0.01),但术后第3天即恢复正常;2组患者术后肾功能及肝功能的ALT、ALP、GGT及LDH以及胃肠道反应和骨髓抑制差异均无统计学意义(P>0.05)。结论梗阻型结直肠癌术中及术后门静脉化疗联合术后FOLFOX4方案化疗能降低术后肿瘤肝脏转移的风险。
Objective To investigate the effect of systemic chemotherapy with FOLFOX4 regimen on portal vein metastasis in patients with obstructive colorectal cancer undergoing intraoperative and postoperative chemotherapy of portal vein. Methods From February 2007 to May 2011, 94 patients with obstructive colorectal cancer who underwent radical resection in our hospital from January 2007 to May 2011 were randomly divided into two groups randomly (envelope method). In the treatment group, 46 patients received intraoperative placement of portal vein Chemotherapy pump at the same time a perfusion chemotherapy, 3 to 4 weeks after surgery FOLFOX4 program systemic chemotherapy plus portal vein infusion chemotherapy 6 courses; control group 48 patients 3 to 4 weeks after the FOLFOX4 regimen only 6 courses of systemic chemotherapy. Toxicities and side effects were compared between the two groups during chemotherapy, and 94 patients were followed up for 3 years to observe the incidence of postoperative liver metastases. Results Tumor liver metastasis occurred in 10 cases (21.7%) in the three-year treatment group and 28 cases (58.3%) in the control group, which was significantly higher than the former (P <0.01). Compared with the control group, AST in the treatment group was significantly higher than that in the control group on the first day after operation (P <0.01), but returned to normal on the third day after operation. The ALT, ALP, GGT and LDH as well as gastrointestinal reactions and myelosuppression were not statistically different (P> 0.05). Conclusions Intraoperative and postoperative portal vein chemotherapy combined with postoperative FOLFOX4 regimen can reduce the risk of postoperative liver metastases in patients with obstructive colorectal cancer.