| ?Background?The characteristics of gastric cancer are "three high"-high incidence,high mortality and high recurrence rate.With the improvement of awareness and prevention of gastric cancer in recent years,the diagnosis of early gastric cancer is greatly increased compared with early onset.The prognosis of patients was improved to a certain extent.The main cause of poor prognosis was recurrence.The data showed that about 40% to 60% of the patients with gastric cancer after radical resection were recurrent in about 40% to 60%,but the recurrence rate of advanced gastric cancer was 50% to 70%,mainly with peritoneal metastasis and 36% to 45% in all recurrence.Although the digestive tract tumors are more sensitive to chemotherapy drugs,conventional systemic venous chemotherapy,due to the existence of the "peritoneal barrier",only small part of the chemotherapy drugs can penetrate the barrier into the peritoneal cavity,and it is difficult to reach the effective drug concentration,and most of the drugs will enter the other important organs to produce the vice.Effect?How to prolong the survival rate and reduce the recurrence rate after radical resection of gastric cancer has become an important field in the diagnosis and treatment of gastric cancer.This promotes the application of neoadjuvant chemotherapy,hyperthermic intraperitoneal chemotherapy and adjuvant chemoradiotherapy.The study shows that the above treatment can significantly reduce the local and distant metastasis of gastric cancer,which also includes peritoneal metastasis of gastric cancer.After a lot of clinical practice and research,it can be found that the prognosis of peritoneal metastasis of gastric cancer is poor compared with the metastasis of other parts,and systemic venous chemotherapy is not good for the prevention and treatment of the recurrence of advanced gastric cancer,and it does not prolong the survival time of the patients.It is suggested that peritoneal metastasis is likely to be one of the stages between local metastasis to systemic metastasis and diffusion,so local control may terminate or delay the process of systemic metastasis and diffusion of gastric cancer.Intraperitoneal hyperthermic perfusion chemotherapy is the birth and development of this concept and its popularization and application in postoperative patients with gastric cancer.?Objective? Objective to evaluate the efficacy and safety of intraperitoneal hyperthermic perfusion chemotherapy combined with systemic intravenous chemotherapy for gastric cancer.?Methods? The computer retrieves the Wanfang database,Chinese sci-tech journal database,Chinese journal full text database,digital periodical full text database,VP journal full text database,Chinese biomedical literature database,Pubmed,Coehrane Library,EMBASE,and other inspection cables,and the publication time is 1998-01~2017.12,the literature is in English and Chinese.All the randomized controlled trials were collected after total systemic venous chemotherapy and postoperative chemotherapy combined with systemic venous chemotherapy for gastric cancer.The quality evaluation of the included literature was carried out,and the quality evaluation criteria were selected in accordance with the characteristics of the study.The integrated data were analyzed with Review Manager software for Meta analysis,and two The survival rate of the patients,the rate of postoperative recurrence and the relative risk of adverse reaction(RR)were used as outcome variables to analyze the efficacy and safety of the clinical application of intraperitoneal hyperthermic chemotherapy.?Results? A total of 16 papers were included,with a total of 2168 patients,including 979 in the experimental group,and 944 in the control group.The results of the experimental group and the control group were analyzed.The results were as follows: the results were as follows: the survival rate of the experimental group was higher than that of the control group,and the recurrence rate was lower than the control group,and the difference was statistically significant.RR and 95%C1 are: 1,2,3,5 year survival rates: [1.08,(1.04,1.12)],[1.06,(0.99,1.13)],[1.27,(1.19,1.36)],[1.76,(1.56,1.99)] and Recurrence rate of 1,2,3,and 5 years is [0.63,(0.35,1.11)]?[0.73,(0.51,1.03)]?[0.62,(0.53,0.72)]?[0.61,(0.55,0.69)].Safety evaluation: the incidence of abdominal pain and abdominal distension in the experimental group and the control group were 59.7% and 24.7% respectively,and RR and 95%CI were [3.69,(2.09,6.51)] the difference was statistically significant;the incidence of nausea and vomiting in the experimental group was slightly lower than that in the control group,but the incidence of renal dysfunction was slightly higher than that in the control group,and the difference was not statistically significant,while the relative risk of side effects such as hair loss,myelosuppression,liver function and neurotoxicity was close to 1,suggesting their hair.There may be no correlation between the rate of birth and the way of chemotherapy.?Conclusions?Compared with the simple systemic venous chemotherapy,the incidence of adverse reactions is approximately equal,and the clinical application is relatively safe.The use of intraperitoneal perfusion chemotherapy combined with systemic venous chemotherapy after gastric cancer surgery can prolong the long-term survival rate and reduce the postoperative recurrence rate. |
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