持续循环腹腔热灌注化疗治疗恶性腹水的临床应用初探

目的探讨腹腔热灌注化疗治疗恶性腹水的可行性、临床初步疗效及不良反应。方法对我院2007年12月-2012年6月收治的23例恶性腹水患者应用腹腔热灌注化疗,18例患者在腹腔镜辅助下完成,5例患者剖腹探查完成。每例患者进行腹腔热灌注化疗5次,首次治疗在手术室内全麻下监护下完成,随后两次在病房或ICU内进行,持续循环灌注生理盐水400-600mL/min,治疗温度(43±0.2)℃,灌注90min,灌注药物根据原发病的不同选择5-氟尿嘧啶加丝裂霉素或卡铂,对其治疗效果进行长期随访。结果腹腔热灌注化疗后23例恶性腹水患者21例腹水全部消失,2例部分缓解,有效率为100%;患者KPS评分上升(P<0.01),肿瘤标志物下降(P<0.05),一般状况、精神状态好转,食欲改善,体重增加,贫血症状明显缓解;热灌注化疗期间患者均感不同程度的腹胀,但尚可忍受,4例患者I°、Ⅱ°骨髓抑制和消化道反应,自行缓解,近期临床疗效满意。随访时间6个月至1年3个月,患者生存期1个半月-13个月,中位生存期7个月,存活最长一例为胃肠道恶性间质瘤患者,存活13个月仍健在。结论腹腔热灌注化疗可保证腹腔内灌注液体速度一致,维持腹腔内温度稳定,维持化疗药物与肿瘤的充分接触,不良反应少,患者可以耐受,是一种安全有效的恶性腹水治疗方法,有着很好的临床应用前景。

The clinic primary application of continous circulatory hyperthermic intraperitoneal chemotherapy in the treatment of malignant ascites from peritoneal carcinomatosis.

【Objective】To investigate the measurement,feasibility and clinic effect of l continous circulatory hyperthermic intraperitoneal chemotherapy（HIPEC） in the treatment of malignant ascites from peritoneal carcinomatosis.【Methods】From Dec.2007 to Jun.2012 HIPEC approach was performed on 23 patients affected by malignant ascites secondary to peritoneal carcinomatosis,in order to associate the benefits of a definitive palliation of ascites with a minimal invasiveness.Every patients was performed HIPEC for five times,the first time were completed in operative room by general anesthesia,the followed four times were performed in patients ward or intensive care unite（ICU）,solution was completed continuous circultary perfusion 400-600mL/min in every HIPEC,and intraperitoneal perfusion of mitomycin-C and cisplatin was delivered for 90min with an inflow temperature of 43 degrees C.And these patients were performed long-term fellowed up HIPEC later.【Resluts】Complete clinical regression of ascites and related symptoms was achieved in all the 21 patients treated,part regression achieved in 2 patients,and 100% clinic effect was acquired in all these patients.Intraoperative course was uneventful in all cases.No postoperative deaths and complication related to the procedure occurred in this study,and satisfy clinic effect had been acquired in these patients treated by HIPEC.And these patients were performed long term followed up HIPEC later,following period was from 6 months to 15 months.All patients of this group had survival times from one and half months to 13 months,with median survival times 7 months.A patient with gastrointestinel stromal tumor with the survival times was 13 months and was still alive at this following time.【Conclusion】 HIPEC appears to be a safe,feasibility and effective procedure to treat debilitating malignant ascites from unresectable peritoneal carcinomatosis,which would have a clinic good perspective in future.