腹腔热灌注化疗在胃癌腹膜转移防治的研究进展与临床应用

Research Progress and Clinical Application of Hyperthermic Intraperitoneal Chemotherapy in the Prevention and Treatment of Gastric Cancer Peritoneal Metastasis

摘要: 胃癌是最常见的消化系统恶性肿瘤之一，同时也是死亡率最高的恶性肿瘤之一，胃癌在我国的患病率和致死率都名列前茅，疾病负担沉重。由于早期诊断困难，国人行早癌筛查率较低等因素影响，晚期胃癌占比较高。胃癌综合治疗效果欠佳的主要原因是腹膜种植转移，如何有效预防进展期胃癌的腹膜复发和转移，改善胃癌患者的预后，延长患者生存期，是胃肿瘤外科研究的焦点和难题。近年来，随着对腹部肿瘤的热化学疗法——即腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy, HIPEC)的深入探讨和应用实践，这种辅助治疗手段已经成为胃肠道肿瘤患者防治腹膜转移的一种重要的补充医疗措施并得到了广泛认可。大量的临床证据表明：该技术可有效防止消化道恶性瘤细胞向胃肠道周围组织扩散、降低淋巴结及远处器官发生浸润转移的可能性；同时还可显著提高一部分已存在于腹膜有明显病灶进展的患者的生活品质和总生存时间。因其具有较高安全性、可重复性等优点而备受关注，成为国内外学者广泛研究和探索的课题之一。本文就HIPEC在胃癌腹膜转移预防和治疗方面的最新研究进展进行全面的综述。

Abstract: Gastric cancer is one of the most common malignant tumors in the digestive system, and also one of the malignant tumors with the highest mortality rate. Gastric cancer ranks among the top in terms of morbidity and mortality in China, with a heavy disease burden. Due to difficulties in early diagnosis and low screening rates for early cancer among Chinese people, advanced gastric cancer accounts for a relatively high proportion. The main reason for the poor comprehensive treatment effect of gastric cancer is peritoneal implantation metastasis. How to effectively prevent peritoneal recurrence and metastasis of advanced gastric cancer, improve the prognosis of gastric cancer patients, and prolong patient survival is a focus and challenge in gastric cancer surgery research. In recent years, with the in-depth exploration and practical application of thermochemical therapy for abdominal tumors, namely hyperthermic intraperitoneal chemotherapy (HIPEC), this adjuvant therapy has become an important supplementary medical measure for the prevention and treatment of peritoneal metastasis in gastrointestinal tumor patients and has been widely recognized. A large amount of clinical evidence indicates that this technology can effectively prevent the spread of malignant tumor cells in the gastrointestinal tract to surrounding tissues, and reduce the possibility of infiltration and metastasis in lymph nodes and distant organs; at the same time, it can significantly improve the quality of life and overall survival time of some patients who have obvious disease progression in the peritoneum. Due to its advantages such as high security and repeatability, it has attracted much attention and has become one of the widely studied and explored topics by scholars at home and abroad. This article provides a comprehensive review of the latest research progress on HIPEC in the prevention and treatment of gastric cancer peritoneal metastasis.