• 1.廣州醫(yī)學(xué)院附屬腫瘤醫(yī)院腹外二科（廣州510095）;;
  • 2.中山大學(xué)公共衛(wèi)生學(xué)院統(tǒng)計(jì)學(xué)教研室（廣州510080）;

目的 探討腹腔熱灌注化療（hyperthermic intraperitoneal perfusion chemotherapy，HIPC）治療進(jìn)展期結(jié)直腸癌的臨床療效和安全性。
方法 應(yīng)用Meta分析的方法對(duì)國(guó)內(nèi)、外已發(fā)表的8篇隨機(jī)對(duì)照研究的文獻(xiàn)進(jìn)行定量綜合，以結(jié)直腸癌根治術(shù)后行HIPC治療的患者為治療組，以僅施行結(jié)直腸癌根治術(shù)的患者為對(duì)照組，比較2組患者5年生存率和3年生存率的結(jié)局變量的相對(duì)危險(xiǎn)度（RR）及安全性。
結(jié)果 入選的8篇文獻(xiàn)共1 501例患者，其中治療組765例，對(duì)照組736例，5年生存率的RR為2.39（95% CI: 1.66～3.45）； 3年生存率的RR為2.13(95% CI: 1.45～3.13)，提示HIPC可提高結(jié)直腸癌患者5年和3年生存率，敏感性分析證實(shí)該結(jié)論較為可靠。入選的5篇文獻(xiàn)對(duì)HIPC的安全性進(jìn)行了描述，結(jié)果表明HIPC的潛在安全問(wèn)題較小。
結(jié)論 進(jìn)展期結(jié)直腸癌根治術(shù)后行HIPC可以提高生存率，改善患者的預(yù)后； 是否會(huì)增加患者術(shù)后并發(fā)癥發(fā)生率目前缺乏相關(guān)性研究，尚無(wú)明確的結(jié)論。

引用本文： 巴明臣,崔書(shū)中,駱福添,歐陽(yáng)文偉,唐云強(qiáng),吳印兵. 腹腔熱灌注化療治療進(jìn)展期結(jié)直腸癌臨床療效及安全性的Meta分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(7): 725-730. doi: 復(fù)制

1. Verwaal VJ, Bruin S, Boot H, et al. 8year followup of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer [J]. Ann Surg Oncol， 2008； 15(9): 24262432.
2. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer [J]. J Clin Oncol， 2003； 21(20): 37373743.
3. Elias D, Benizri E, Di Pietrantonio D, et al. Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis[J]. Ann Surg Oncol， 2007； 14(2): 509514.
4. 吳承堂, 黃祥成, 卿三華. 直腸癌術(shù)式和熱灌注化療與預(yù)后的關(guān)系 [J]. 中華胃腸外科雜志, 2001； 4(2)： 8890.
5. Verwaal VJ, van Ruth S, Witkamp A, et al. Longterm survival of peritoneal carcinomatosis of colorectal origin [J]. Ann Surg Oncol, 2005； 12(1): 6571.
6. 王付龍, 侯?lèi)?ài)軍, 彭正. 結(jié)直腸癌切除術(shù)中腹腔低滲熱灌注化療的臨床研究 [J]. 華北國(guó)防醫(yī)藥, 2006； 18(2): 100102.
7. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin [J]. J Clin Oncol, 2009； 27(5): 681685.
8. Kianmanesh R, Scaringi S, Sabate JM, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases [J]. Ann Surg, 2007； 245(4): 597603.
9. Yan TD. Peritoneal carcinomatosis of colorectal origin: standard of care [J]. Ann Surg, 2006； 224(4): 632633.
10. Glockzin G, Ghali N, Lang SA, et al. Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer [J]. J Surg Oncol, 2009； 100(4): 306310.
11. Brouquet A, Goéré D, Lefèvre JH, et al. The second procedure combining complete cytoreductive surgery and intraperitoneal chemotherapy for isolated peritoneal recurrence: postoperative course and longterm outcome [J]. Ann Surg Oncol, 2009； 16(10): 27442751.
12. Hagendoorn J, van Lammeren G, Boerma D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal and gastrointestinal origin shows acceptable morbidity and high survival[J]. Eur J Surg Oncol, 2009； 35(8)：833837.
13. Huh JW, Kim YJ, Kim HR. Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis[J]. World J Gastroenterol, 2009; 15(6): 756757.
14. 劉義冰, 劉巍, 洪雷, 等. 腹腔熱灌注化療毒副作用的觀察及分析 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010； 17(3): 237239.
15. 何建苗, 蒲永東, 曹志宇, 等. 胃癌患者腹腔游離癌細(xì)胞的監(jiān)測(cè)與腹腔灌注化療 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2002； 9(3): 156158.
16. Franko J, Gusani NJ, Holtzman MP, et al. Multivisceral resection does not affect morbidity and survival after cytoreductive surgery and chemoperfusion for carcinomatosis from colorectal cancer [J]. Ann Surg Oncol, 2008； 15(11): 30653072.
17. Zanon C, Bortolini M, Chiappino I, et al. Cytoreductive surgery combined with intraperitoneal chemohyperthermia for the treatment of advanced colon cancer [J]. World J Surg, 2006； 30(11): 20252032.
18. 毛忠琦, 陸耀良, 徐乃元. 腹腔化療對(duì)大鼠結(jié)腸吻合口愈合的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2002； 9(5): 335337.
19. Cao C, Yan TD, Black D, et al. A systematic review and metaanalysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin [J]. Ann Surg Oncol, 2009； 16(8): 21522165.
  1. 1. Verwaal VJ, Bruin S, Boot H, et al. 8year followup of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer [J]. Ann Surg Oncol， 2008； 15(9): 24262432.
  2. 2. Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer [J]. J Clin Oncol， 2003； 21(20): 37373743.
  3. 3. Elias D, Benizri E, Di Pietrantonio D, et al. Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis[J]. Ann Surg Oncol， 2007； 14(2): 509514.
  4. 4. 吳承堂, 黃祥成, 卿三華. 直腸癌術(shù)式和熱灌注化療與預(yù)后的關(guān)系 [J]. 中華胃腸外科雜志, 2001； 4(2)： 8890.
  5. 5. Verwaal VJ, van Ruth S, Witkamp A, et al. Longterm survival of peritoneal carcinomatosis of colorectal origin [J]. Ann Surg Oncol, 2005； 12(1): 6571.
  6. 6. 王付龍, 侯?lèi)?ài)軍, 彭正. 結(jié)直腸癌切除術(shù)中腹腔低滲熱灌注化療的臨床研究 [J]. 華北國(guó)防醫(yī)藥, 2006； 18(2): 100102.
  7. 7. Elias D, Lefevre JH, Chevalier J, et al. Complete cytoreductive surgery plus intraperitoneal chemohyperthermia with oxaliplatin for peritoneal carcinomatosis of colorectal origin [J]. J Clin Oncol, 2009； 27(5): 681685.
  8. 8. Kianmanesh R, Scaringi S, Sabate JM, et al. Iterative cytoreductive surgery associated with hyperthermic intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis of colorectal origin with or without liver metastases [J]. Ann Surg, 2007； 245(4): 597603.
  9. 9. Yan TD. Peritoneal carcinomatosis of colorectal origin: standard of care [J]. Ann Surg, 2006； 224(4): 632633.
  10. 10. Glockzin G, Ghali N, Lang SA, et al. Results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer [J]. J Surg Oncol, 2009； 100(4): 306310.
  11. 11. Brouquet A, Goéré D, Lefèvre JH, et al. The second procedure combining complete cytoreductive surgery and intraperitoneal chemotherapy for isolated peritoneal recurrence: postoperative course and longterm outcome [J]. Ann Surg Oncol, 2009； 16(10): 27442751.
  12. 12. Hagendoorn J, van Lammeren G, Boerma D, et al. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal and gastrointestinal origin shows acceptable morbidity and high survival[J]. Eur J Surg Oncol, 2009； 35(8)：833837.
  13. 13. Huh JW, Kim YJ, Kim HR. Complete peritonectomy and intraperitoneal chemotherapy for recurrent rectal cancer with peritoneal metastasis[J]. World J Gastroenterol, 2009; 15(6): 756757.
  14. 14. 劉義冰, 劉巍, 洪雷, 等. 腹腔熱灌注化療毒副作用的觀察及分析 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010； 17(3): 237239.
  15. 15. 何建苗, 蒲永東, 曹志宇, 等. 胃癌患者腹腔游離癌細(xì)胞的監(jiān)測(cè)與腹腔灌注化療 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2002； 9(3): 156158.
  16. 16. Franko J, Gusani NJ, Holtzman MP, et al. Multivisceral resection does not affect morbidity and survival after cytoreductive surgery and chemoperfusion for carcinomatosis from colorectal cancer [J]. Ann Surg Oncol, 2008； 15(11): 30653072.
  17. 17. Zanon C, Bortolini M, Chiappino I, et al. Cytoreductive surgery combined with intraperitoneal chemohyperthermia for the treatment of advanced colon cancer [J]. World J Surg, 2006； 30(11): 20252032.
  18. 18. 毛忠琦, 陸耀良, 徐乃元. 腹腔化療對(duì)大鼠結(jié)腸吻合口愈合的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2002； 9(5): 335337.
  19. 19. Cao C, Yan TD, Black D, et al. A systematic review and metaanalysis of cytoreductive surgery with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal origin [J]. Ann Surg Oncol, 2009； 16(8): 21522165.