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目的观察术中白芨顺铂微粒和125I近距离放化疗治疗进展期胃癌的近、远期疗效和毒副反应。方法纳入接收根治性手术的Ⅱ、Ⅲ期胃癌患者176例,随机分为近距离放化疗组(n=48)、腹腔化疗组(n=32)和静脉化疗组(n=48),并将术后自动放弃放、化疗的患者,在签署知情同意书后,选择作为对照组(n=48),观察各组患者近、远期随访结果和毒副反应,并通过Kaplan-Meier法和Log-Rank检验分析各组患者的生存情况。结果近期随访结果:近距离放化疗组总有效率为95.83%,腹腔化疗组总有效率为71.88%,静脉化疗组总有效率为64.58%,对照组总有效率为52.08%。4组间总有效率的差异有统计学意义(P<0.05),其中对照组与近距离放化疗组比较,差异有统计学意义(P<0.01)。远期随访结果:近距离放化疗组3年和5年死亡率为37.50%和56.32%,5年中位生存期为(14±4.51)个月(95%CI:14.419～4.512);腹腔化疗组3年和5年死亡率为78.12%和93.75%,5年中位总体生存期为(10.6±1.13)个月(95%CI:10.620～1.163);静脉化疗组3年和5年死亡率为79.21%和95.80%,5年中位总体生存期为(11±3.10)个月(95%CI:11.130～3.162);对照组3年和5年死亡率为87.50%和95.83%,5年中位总体生存期为(9±2.30)个月(95%CI:10.024～1.18)。与静脉化疗组相比较,近距离放化疗组恶心、呕吐、骨髓抑制、肝功能损害及肾功损害的发生率明显降低(P<0.05)。结论对进展期胃癌术中进行白芨顺铂微粒和125I近距离放化疗治疗可减少药物的毒副反应,延长患者生存期。
Objective To observe the short-term and long-term efficacy and side effects of cisplatin and 125I brachytherapy in the treatment of advanced gastric cancer. Methods One hundred and sixty-six patients with stage II and III gastric cancer receiving radical surgery were randomly divided into brachytherapy group (n = 48), intraperitoneal chemotherapy group (n = 32) and intravenous chemotherapy group (n = 48) Patients who had given up radiotherapy and chemotherapy after surgery were selected as control group (n = 48) after informed consent, and the follow-up results and adverse reactions of each group were observed and analyzed by Kaplan-Meier method and Log- Rank test analysis of the survival of patients in each group. Results The follow-up results: The total effective rate of brachytherapy group was 95.83%, the total effective rate of intraperitoneal chemotherapy group was 71.88%, the total effective rate of intravenous chemotherapy group was 64.58%, and the control group’s total effective rate was 52.08%. There was significant difference in the total effective rate between the 4 groups (P <0.05), and the difference between the control group and the brachytherapy group was statistically significant (P <0.01). Long-term follow-up results: The 3-year and 5-year mortality rates of brachytherapy group were 37.50% and 56.32%, respectively. The 5-year median survival time was 14 ± 4.51 months (95% CI: 14.419-4.512) The 3-year and 5-year mortality rates were 78.12% and 93.75%, respectively. The 5-year median overall survival was (10.6 ± 1.13) months (95% CI: 10.620 ~ 1.163). The 3- and 5-year mortality rates The median 5-year overall survival was (11 ± 3.10) months (95% CI: 11.130 to 3.162). The 3-year and 5-year mortality rates in the control group were 87.50% and 95.83% The median overall survival was (9 ± 2.30) months (95% CI: 10.024 to 1.18). Compared with the intravenous chemotherapy group, the incidence of nausea, vomiting, myelosuppression, hepatic dysfunction and renal damage in brachytherapy group was significantly lower than that in the intravenous chemotherapy group (P <0.05). Conclusion Intraoperative cisplatin nanoparticles and 125I brachytherapy in patients with advanced gastric cancer can reduce the side effects of drugs and prolong the survival of patients.