Hiratsuka M, Furukawa H, Yasuda T, Murata K, Nakano H, Ohigashi H, Kameyama M, Sasaki Y, Kabuto T, Ishikawa O, Imaoka S
Dept. of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases.
Gan To Kagaku Ryoho. 1998 Jul;25(9):1445-8.
Prognosis of patients with macroscopically negative but microscopically positive peritoneal dissemination is so poor that the two-year survival rate after the surgery was 0% during 1975-1981. It improved to 38% during 1982-1988 but the five year survival rate was 0%.
A 57-year-old male underwent distal gastrectomy and lymph node dissection on November 10, 1992 due to Borrmann type 3 gastric cancer measuring 5.4 cm in diameter and locating in the gastric antrum (H0 P0 t3 n3 stage IV a). Peritoneal lavage cytology revealed cancer cells, and, thus, this patient was treated with intraperitoneal chemotherapy using an intraperitoneal infuser port. Through the infuser port, cisplatin and 5-FU were given at a dose of 70 mg/m2 and 700 mg/m2, respectively. Because fluorouracil infusion caused abdominal pain after the second infusion, it was administered i.v. for 24 hours thereafter. The infuser port was removed after the four infusions because the patient developed appendicitis. Fluorouracil was given p.o. at a dose of 300 mg/day from one month after surgery (total dose of fluorouracil 54.6 g). Cytological examination of the ascites revealed no cancer cells after the second intraperitoneal chemotherapy, and the patient fared well five years and four months after the surgery. Therefore, it is suggested that intraperitoneal chemotherapy with cisplatin and fluorouracil is an effective treatment for microscopical peritoneal dissemination, though it may have an adverse effect such as chemical peritonitis.
宏观上阴性但微观上阳性的腹膜播散患者预后极差，在1975 - 1981年期间，手术后的两年生存率为0%。在1982 - 1988年期间生存率提高到了38%，但五年生存率仍为0%。
一名57岁男性因直径5.4厘米、位于胃窦的Borrmann 3型胃癌（H0 P0 t3 n3 四期a）于1992年11月10日接受了远端胃切除术和淋巴结清扫术。腹腔灌洗细胞学检查发现癌细胞，因此该患者使用腹腔内输注端口进行腹腔内化疗。通过输注端口，分别给予顺铂和5 - 氟尿嘧啶，剂量分别为70毫克/平方米和700毫克/平方米。由于第二次输注后氟尿嘧啶输注引起腹痛，此后改为静脉输注24小时。在四次输注后，由于患者发生阑尾炎，移除了输注端口。术后一个月起口服氟尿嘧啶，剂量为300毫克/天（氟尿嘧啶总剂量54.6克）。第二次腹腔内化疗后腹水细胞学检查未发现癌细胞，患者术后五年零四个月情况良好。因此，尽管顺铂和氟尿嘧啶腹腔内化疗可能有化学性腹膜炎等不良反应，但提示其对微观腹膜播散是一种有效的治疗方法。
