摘要
目的探讨胃癌术后早期腹腔热灌注化疗的可行性、安全性及短期疗效。方法对2002年7月至2003年12月对15例进展期胃癌和1例吻合口复发癌,术中行根治或姑息性切除;对直径≥0.5cm的腹腔内转移灶用电刀减量戮灭。术后第1天开始,每日腹腔热灌注化疗1次,每次60～90min,一般4次为1疗程,计做64次。结果循环通畅率96.9%(62/64),治疗时间内腹腔内温度80%达到41℃以上,各出水管温度均超过41℃,并保持60～90min。并发症及毒副反应有:轻度腹腔感染2例,吻合口漏1例,腹痛4例,恶心呕吐2例,转氨酶轻度升高1例。随访6～27个月,术后每3个月复查1次B超或CT,腹腔转移3例,腹腔转移率为18.8%,1例术后6个月死于全身广泛转移,另1例术后13个月死于腹腔转移及肝转移。最长1例随访时间为27个月,现仍存活。结论术后早期腹腔热灌注化疗安全,腹腔内温度较均匀,可多次进行,并发症少及毒副反应小,有利于胃癌术后腹腔内较小的残余癌或游离癌细胞的杀灭。
Objective To evaluate the feasibility,safety and short-term efficacy of chemohyperthermic peritoneal perfusion (CHPP) by monitoring the progress of patients following the resection of gastric carcinoma.Methods From July 2002 to December 2003,15 patients with advanced gastric carcinoma and 1 with recurrent cancer of anastomotic stoma were performed radical dissection or palliative resection and intraperitoneal metastases in diameter of ≥0.5 cm were reduced using electrical knife.Several perfusion tubes entering and exiting the peritoneal cavity were maintained after closing the abdomen.The patients underwent CHPP immediately on postoperative day 1.The hyperthermic perfusion was maintained for 60~90 min per day.Typically one treatment cycle was repeated 4 times.Results Circulation was sufficiently fluent for treatment in approximately 96.9%(62/64) of patients.The mean intraperitoneal temperature during perfusion was maintained above 41℃ in 80% of patients.Mean perfusate temperature was maintained above 41℃ for 60~90 min.Complications included minor intraperitoneal infections in 2 patients,leaking of the staple line or suture line in 1 patient,abdominal pain in 4 patients,nausea and vomiting in 2 patients,transaminase concentration marginally higher in 1 patient.Follow up survey of 6~27 months and Ultrasonography or Computerized Tomography carried every 3 months showed intraperitoneal metastasis in 3 (18.8%) patients.One patient died from broad metastasis in 6 months and one from intraperitoneal and liver metastasis in 13 months.Furthermore,one patient still lives in 27 months.Conclusion Given the stability of the temperature during perfusion,the mildness of observed side effects and the potential for repeated administrations CHPP should be safety and beneficial to eliminating small remained cancer or dissociative cancer cells in the patients following curative resection of gastric carcinomas.
出处
《中国实用外科杂志》
CSCD
北大核心
2005年第7期404-406,共3页
Chinese Journal of Practical Surgery
