Klausner J M, Lelcuk S, Inbar M, Rozin R
Arch Surg. 1986 Feb;121(2):239-42. doi: 10.1001/archsurg.1986.01400020125017.
Administration of chemotherapy is delayed by most clinicians until complete recovery from surgery because it is generally feared that cytotoxic drugs impair wound healing, reduce resistance against infection, and may hinder the recovery process. However, clinical experience is lacking. This clinical study examines the effect of perioperative administration of fluorouracil on the healing of wounds and intestinal anastomoses and the recovery process in general. Forty patients with advanced gastrointestinal tract cancers entered the study. Intravenous bolus administration of 0.5 g of fluorouracil was started during surgery. The patients underwent a variety of abdominal operations for palliation or cure. A total of 22 gastric and enteric anastomoses were performed. One half gram of fluorouracil diluted in 150 mL of 5% glucose solution was given intravenously over one hour daily for ten days postoperatively. The patients were carefully evaluated for any alteration in the postoperative recovery. Thirty-eight of the 40 patients received the full course of fluorouracil. Twenty-one patients had an uneventful postoperative course. Eighteen had mild to moderate respiratory and cardiovascular complications unrelated to fluorouracil administration. One patient died of pulmonary emboli 16 days after abdominoperineal resection. Surgical wounds healed without complications in 37 patients. One case of wound disruption occurred after sigmoidectomy. Two patients developed wound infections that healed secondarily. All 22 patients with anastomoses recovered without any evidence of leakage. Colostomies and gastrostomies functioned as anticipated. Side effects attributed to fluorouracil appeared in seven of the patients; in only two of the patients were complications life-threatening, involving bone marrow depression. All patients recovered after discontinuation of fluorouracil therapy and with supportive treatment. On the whole, the course of recovery of this group was no different than expected from patients with advanced malignant neoplasms who were undergoing extensive surgery. Based on this study, it seems that fluorouracil administration during and immediately after surgery has no deleterious effect on wound healing and recovery.
大多数临床医生会推迟化疗，直到手术完全康复，因为人们普遍担心细胞毒性药物会损害伤口愈合、降低抗感染能力，并可能阻碍康复进程。然而，缺乏临床经验。这项临床研究考察了围手术期给予氟尿嘧啶对伤口和肠吻合口愈合以及总体康复进程的影响。40例晚期胃肠道癌患者进入该研究。手术期间开始静脉推注0.5克氟尿嘧啶。患者接受了各种腹部手术以缓解症状或进行根治。共进行了22例胃和肠吻合术。术后十天，每天将半克氟尿嘧啶稀释于150毫升5%葡萄糖溶液中，静脉滴注一小时。仔细评估患者术后康复的任何变化。40例患者中有38例接受了全程氟尿嘧啶治疗。21例患者术后恢复顺利。18例有轻度至中度与氟尿嘧啶给药无关的呼吸和心血管并发症。1例患者在腹会阴切除术后16天死于肺栓塞。37例患者手术伤口愈合无并发症。1例患者在乙状结肠切除术后出现伤口裂开。2例患者发生伤口感染，后来愈合。所有22例吻合术患者均康复，无任何渗漏迹象。结肠造口术和胃造口术功能正常。7例患者出现了归因于氟尿嘧啶的副作用；只有2例患者出现危及生命的并发症，涉及骨髓抑制。所有患者在停用氟尿嘧啶治疗并接受支持治疗后康复。总体而言，该组患者的康复过程与接受大型手术的晚期恶性肿瘤患者预期的康复过程没有差异。基于这项研究，似乎手术期间及术后立即给予氟尿嘧啶对伤口愈合和康复没有有害影响。
