顺铂联合高聚生腹腔灌注治疗37例恶性腹水的体会

目的　评价顺铂 (DDP)联合高聚生 (HASL)腹腔灌注治疗恶性腹水的效果。方法　将49例恶性腹水病人随机分为治疗组 (顺铂联合高聚生腹腔灌注 ) 37例和对照组 (单一顺铂腹腔灌注 )12例 ,治疗出院后分别随访 ,比较两组的治疗效果及生存期限。结果　治疗组完全有效 (CR) 2 8例 ,部分有效 (PR) 7例 ,无变化 (NC) 2例 ,总有效率 94.6 % (35 / 37) ,对照组CR2例 ,PR3例 ,NC7例 ,总有效率 41.7% (5 / 12 )。治疗组生存 4～ 2 2个月 ,平均生存 12 .3个月 ;对照组生存 2～ 7.5个月 ,平均生存4.5个月。结论　顺铂联合高聚生腹腔灌注治疗恶性腹水疗效确切 ,安全可靠 ,可明显改善病人生活质量 ,提高病人生存期限。     

腹腔镜辅助腹腔热灌注化疗治疗结直肠癌引起的恶性腹水临床疗效及安全性

目的探讨腹腔镜辅助腹腔热灌注化疗(HIPEC)治疗结直肠癌引起恶性腹水的临床疗效及安全性。 方法回顾性分析2014年1月至2015年5月诊断结直肠癌并合并恶性腹水患者35例,分为原发组19例和术后复发组16例,均进行腹腔镜辅助置管腹腔热灌注化疗。采用SPSS 20.0统计分析软件进行分析,HIPEC治疗有效率和术后并发症采用卡方检验;KPS评分采用均数±标准差表示,独立t检验,P<0.05为差异有统计学意义。 结果HIPEC治疗后总有效率为100%,其中完全缓解率85.7%(30/35);两组患者灌注后4周KPS评分较灌注前上升0～20分,原发组上升更明显(P＝0.000);术后复发组不良反应发生率显著高于原发组(P<0.05)。 结论腹腔镜辅助置管HIPEC能缓解结直肠癌引起的恶性腹水,提高患者的生活质量,具有良好的安全性。     

循环热灌注大剂量顺铂治疗胃肠道肿瘤腹水的临床研究

目的 探讨循环热灌注大剂量顺铂治疗胃肠道肿瘤腹水的近期疗效,并对其并发症进行分析.方法 29例胃肠道肿瘤腹水患者通过腹腔内穿刺置双管建立循环双通路,先行单向灌洗放出腹腔积液;再行循环热灌注,并于灌注液中加入大剂量顺铂,观察其疗效及并发症.结果 本组29例患者接受腹腔内循环热灌注大剂量顺铂2个疗程后评价疗效,均未出现肾脏毒性、腹膜炎、耳毒性、肠粘连和肠梗阻,其中完全缓解9例,部分缓解16例,稳定3例,无效1例,有效率为86.2%,16 例（55.2%）患者出现胃肠道反应,9例（31.0%）患者出现白细胞下降.结论 腹腔内循环热灌注大剂量顺铂化疗治疗胃肠道肿瘤腹水安全、微创、不良反应少而轻、近期疗效明显.     

腹腔镜手术治疗同时性胃肠道多原发癌的临床疗效

目的 探讨腹腔镜手术治疗同时性胃肠道多原发癌的安全性和可行性.方法 回顾性分析2009年1月至2014年1月中山大学附属第三医院19例行腹腔镜手术治疗同时性胃肠道多原发癌患者的临床资料.术后通过门诊或住院复诊、电话及信件方式随访,随访时间截至2014年4月或患者死亡.结果 19例患者手术顺利,其中腹腔镜辅助远端胃癌根治+直肠前切除术3例;腹腔镜辅助远端胃癌根治+胰十二指肠切除术1例;腹腔镜辅助右半结肠切除+胃体胃肠道间质瘤楔形切除术1例;腹腔镜辅助右半结肠切除+直肠前切除术4例;腹腔镜辅助左半结肠切除+直肠前切除术4例;腹腔镜辅助乙状结肠切除+直肠切除术6例.平均手术时间为228 min(145～ 380 min),辅助切口平均长度为5 cm(4～7 cm),术中平均出血量为86 mL(10～250 mL),无中转开腹患者.平均清扫淋巴结数目为39枚(21 ～58枚),平均阳性淋巴结数目为3枚(0～6枚).术后拔除腹腔引流管平均时间为3 d(2～6 d),术后恢复进食平均时间为4d(2 ～7 d),术后平均住院时间为10 d(7 ～21 d).术后并发切口感染1例,经对症处理后痊愈出院.患者术后平均随访时间为24个月(3 ～48个月),1例失访,12例无瘤生存,4例带瘤生存,2例因肿瘤相关原因死亡.结论 腹腔镜手术治疗同时性胃肠道多原发癌是安全、可行的,且具有创伤小、恢复快的优点.     

双镜联合治疗复杂性结肠息肉30例临床分析

目的探讨电子结肠镜联合腹腔镜手术治疗复杂结肠息肉的可行性与安全性。方法回顾性分析30例基底直径≥2．0cm,位置特殊,无法内镜下摘除的结肠息肉,在电子结肠镜辅助下行腹腔镜手术治疗的近期疗效。结果30例均在双镜联合下顺利完成手术,其中肠镜辅助腹腔镜下部分肠壁切除19例,腹腔镜下肠段切除6例,双镜联合小切口辅助部分肠切除3例,术中病理证实为恶性者行腹腔镜结肠癌根治术2例。手术时间50～185min,平均（79．6±28．6）min;术后无吻合口漏和吻合口梗阻发生;有1例患者出现吻合口出血,经保守治疗痊愈。术后肠功能恢复时间1～4d,平均（2-3±2．7）d;住院时间3～12d,平均（5．0±2．0）d。术后随访6—15个月,平均（9．8±2．7）个月;除6例失随访外,24例复查肠镜未见息肉残留、复发。结论腹腔镜联合电子结肠镜不仅定位准确,对恶性患者更改切除术式灵活,而且术后并发症发生率较低,是一种治疗复杂结肠良恶性息肉安全、有效的方法。     

514例肝血管瘤的治疗与临床评分

目的 探讨肝血管瘤不同治疗方式的临床疗效,提出肝血管瘤临床评分并评价其应用价值.方法 回顾性分析2002年1月至2013年12月新疆医科大学第一附属医院收治的514例肝血管瘤患者的临床资料.患者分别施行手术切除、肝动脉栓塞术(TAE)、RFA治疗或随访观察,观察其治疗情况,手术时间,术后1周ALT水平,术后住院时间,术后并发症等,评价其临床疗效.根据患者临床症状、肿瘤直径、位置、肿瘤直径增长速度4项相关因素,提出肝血管瘤临床评分:分值≥4分者可考虑行手术治疗,对不宜或不愿行手术切除者,可考虑TAE或随访观察;分值＜4分且未合并危险因素者可随访观察,合并者视患者个体情况选择个性化随访、再评估后手术切除、TAE或RFA.采用门诊及电话随访.随访时间截至2014年6月.结果 (1)治疗情况:①手术疗效,380例患者肿瘤完整切除.195例患者症状缓解,17例患者症状缓解不明显,手术时间为(175±15) min,术后1周ALT为(139±14) U/L,术后住院时间为(11.5±1.4)d,术后发生并发症58例.②TAE疗效,37例患者行TAE,术后CT检查示1例患者瘤体未见强化;36例瘤体部分强化,体积缩小25％ ～ 90％.13例患者症状缓解,10例患者症状缓解不明显,手术时间为(67 ± 13) min,术后1周ALT为(64±13) U/L,术后住院时间为(6.8±0.7)d,术后发生并发症2例.③RFA疗效,16例患者行RFA,术后CT检查示2例患者瘤体未见强化;14例瘤体部分强化,体积缩小29％～72％.3例患者症状缓解,1例患者未缓解,手术时间为(75±26) min,术后1周ALT为(41±18) U/L,术后住院时间为(5.3±2.7)d.④随访观察情况,81例仅随访观察患者中24例症状消失,8例未缓解,49例仍无症状.20例肿瘤缓慢增大,3例因肿瘤增大迅速行手术切除,无并发症发生.(2)临床评分:分值≥4分患者176例,手术切除159例,TAE 8例,随访观察9例;分值＜4分患者338例,手术切除221例,TAE29例,RFA 16例,随访观察72例.(3)随访情况:所有患者获得随访,随访时间为6～ 150个月,平均随访时间为89个月,患者恢复良好.结论 手术切除是治疗肝血管瘤的有效方法,TAE及RFA具有创伤小的优点,但疗效欠佳,随访观察可作为暂无手术指征患者的选择.肝血管瘤临床评分可作为选择治疗方式的参考依据,但应结合患者具体情况决定治疗方式.     

腹腔镜联合结肠镜治疗复杂、特殊类型的结直肠息肉

目的探讨腹腔镜联合结肠镜治疗结直肠息肉的疗效。方法良性息肉行腹腔镜辅助结肠镜下息肉切除术,腹腔镜辅助结肠镜下息肉切除困难者或有风险者可选用结肠镜辅助腹腔镜下肠段切除术,复杂病例采用混合术式（腹腔镜辅助结肠镜下息肉切除术＋结肠镜辅助腹腔镜下肠段切除术）。结果腹腔镜辅助结肠镜下息肉切除术14例,手术时间55～158min,平均103min。结肠镜辅助腹腔镜下结肠癌根治术2例,手术时间分别为182、206min。结肠镜辅助腹腔镜降结肠部分切除术（降结肠多发息肉,其中1枚息肉为无蒂息肉）1例,手术时间98rain。混合术式2例,手术时间分别为102、166min。19例术后随访10～48个月,平均28个月,无一例息肉残留、复发或再次手术。结论腹腔镜联合结肠镜治疗结直肠息肉疗效满意。     

后腹腔镜半肾输尿管切除术治疗成人重复肾(附25例报告)

目的 探讨后腹腔镜半肾输尿管切除手术治疗成人重复肾的手术方法和临床效果.方法 对2008年1月～2012年6月行后腹腔镜下重复肾切除术25例患者的治疗效果进行随访并总结分析.25例患者均术前行磁共振尿路水成(MRU)、静脉尿路造影(IVU)和B超确诊重复肾.结果 25例手术均成功.手术时间70～ 220min,平均87min.术中出血量35～200mL,平均64mL.术后住院时间6～8d,平均6.5d.术中和术后未出现明显并发症.随访3～20个月,平均9个月.患者术前原有症状消失,下半肾功能良好.结论 后腹腔镜重复肾切除术安全可靠,疗效良好,患者恢复速度快.     

胃镜辅助腹腔镜改良Heller手术治疗贲门失弛缓症

目的:探讨胃镜辅助下腹腔镜改良Heller手术治疗贲门失弛缓症的疗效及并发症。方法:为35例贲门失弛缓症患者行胃镜辅助腹腔镜改良Heller术,观察术后症状的解除及并发症情况,随访最少1年,观察术后短期疗效。结果:手术时间60~200 min,出血量10~200 ml。术后住院4~7 d,无一例中转开腹,术后症状均有明显改善。2例患者术中损伤食管黏膜,镜下修补后未出现食管瘘。术后2个月复查钡餐,均未见梗阻,食管扩张较前改善;复查24 h食管pH值基本正常,pH4的时间占(1.4%±2.7%),pH监测的患者中5例(14.3%)提示有病理性酸反流,仅1例患者有轻度症状,保守治疗后症状缓解。术前食管测压显示食管下括约肌压力升高,术后2个月复查压力明显下降。随访1年以上,1例于术后5个月出现食管梗阻,扩张治疗后好转。结论:胃镜辅助腹腔镜改良Heller手术治疗贲门失弛缓症效果明显,并发症少,可在临床上推广应用。     

腹腔镜粘连松解术治疗粘连性肠梗阻27例临床分析

目的探讨腹腔镜粘连松解术治疗粘连性肠梗阻的应用价值。方法对我院2005年7月至2011年9月期间采用腹腔镜进行肠粘连松解术的27例患者的临床资料进行回顾性分析。结果 27例患者中除2例因术中探查发现小肠坏死而中转开腹行肠切除外,其余25例均手术成功,手术时间(65±15)min(40～115 min)。27例均获随访,随访时间(14±6)个月(8个月～2年),1例患者于术后1个月时有阵发性腹痛,经保守治疗缓解,其余病例均无腹胀、腹痛等症状发生。结论腹腔镜粘连松解术治疗粘连性肠梗阻具有创伤小、恢复快的优点,是较理想的治疗术后肠粘连的手段。     

Multivariate comparison of B-ultrasound guided and laparoscopic continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy for malignant ascites

Objective

Clinical efficacy of B-ultrasound–guided and laparoscopy-assisted continuous hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) for treatment of malignant ascites was investigated.

Methods

Sixty-two patients with malignant ascites induced by ovarian or gastrointestinal cancers were randomly treated with B-ultrasound–guided CHIPC (therapeutic group) or laparoscopy-assisted CHIPC (control group) performed at the same center. Hospitalization costs and surgical duration were evaluated. Follow-up was conducted for 21 months with B-ultrasound or computed tomography at least once per month for assessment of ascites amount and tumor progression. Clinical efficacy was assessed by modified World Health Organization criteria. Survival time, Karnofsky performance score (KPS) of quality of life (QOL), and complications were recorded for all patients.

Results

Overall condition, primary disease type, and ascites amounts were comparable between groups. Significantly shorter mean duration of perfusion catheter placement (35 vs. 85 min) and mean hospitalization cost (36,000 vs. 55,000 ¥/patient) were observed in the therapeutic group than the control group (P < 0.01). Significantly different KPS scores were not observed before or after CHIPC (23.13 vs. 22.64 %) in both groups (P > 0.05). No significant differences in objective remission rates of malignant ascites (93.75 vs. 93.34 %), median survival times (9 vs. 8 months), or stamp hole metastasis rates (18.75 vs. 18.15 %) were observed between groups (P > 0.05).

Conclusions

B-ultrasound–guided and laparoscopy-assisted CHIPC have similar clinical efficacy for improving QOL and prolonging patient survival. B-ultrasound–guided CHIPC may, however, shorten operation times and reduce hospitalization costs, making the treatment available to a broader patient population, although port hole metastasis remains an issue.     

Cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of gastrointestinal origin

No standard effective treatment exists for peritoneal carcinomatosis of gastrointestinal origin. The pharmacokinetic advantage of intraperitoneal chemotherapy and the synergy of heat and certain anticancer agents have prompted researchers to investigate intraperitoneal hyperthermic chemotherapy in treating disseminated peritoneal cancers. We have conducted a large Phase II trial to determine the safety and efficacy of aggressive cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) in treating peritoneal carcinomatosis of gastrointestinal origin. Patients with disseminated peritoneal carcinomatosis of gastrointestinal origin with or without malignant ascites were eligible. After aggressive surgical debulking, patients were administered a 2-hour heated (40.5 degrees C) intraperitoneal perfusion with mitomycin C. The major response variable monitored was overall survival. Patients were assessed for toxicity after IPHC administration using the National Cancer Institute Common Toxicity Criteria. Eighty-four patients with peritoneal carcinomatosis of gastrointestinal origin were evaluated for survival and toxicity (colon, n = 38; appendix, n = 22; stomach, n = 19; other gastrointestinal, n = 5). Thirty-nine (46%) patients had malignant ascites at the time of therapy. The operative mortality (30-day) was 6 per cent. Hematologic toxicity was the most common toxicity but was of mild to moderate severity (7 and 4% of patients had grade 3/4 white blood cell or platelet toxicity, respectively). The overall median survival was 14.3 months. The median survival of patients with peritoneal carcinomatosis of appendiceal, colorectal, and gastric origins were 31.1+, 14.6, and 10.1 months, respectively. Significant differences in median survival were seen in patients without and with malignant ascites (27.7 vs 7.6 months; P = 0.0004) and R0/R1 (complete gross tumor resection) versus R2 (gross residual tumor) surgical resection status (28.5+ vs 10.8 months, P = 0.0002). These data suggest that aggressive cytoreductive surgery with IPHC using mitomycin C is safe and effective in treating peritoneal carcinomatosis of gastrointestinal origin. Additional studies and broader applications of this treatment are encouraged.     

肿瘤细胞减灭术联合腹腔热灌注化疗治疗腹膜癌1384例疗效分析

目的腹膜癌是一类原发或继发于腹膜表面的恶性肿瘤,肿瘤细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC)是针对腹膜癌发展的一套综合治疗策略。本文旨在分析CRS+HIPEC治疗腹膜癌的疗效和安全性,并探讨影响其生存的预后因素。方法采用描述性病例系列研究方法,回顾性收集2004年1月至2020年1月武汉大学中南医院(330例)和首都医科大学附属北京世纪坛医院(1054例)腹膜肿瘤外科连续治疗的1384例腹膜癌患者的临床病理资料。分析本组患者CRS+HIPEC治疗情况(手术时间、器官切除数量、腹膜切除数量、吻合口数量、HIPEC方案等)、安全性[术中出血量、术后严重不良事件(SAE)及发生时间、治疗情况]、生存情况及影响生存的预后因素。SAE依照国际腹膜癌联盟不良事件定义进行分级,将Ⅲ~Ⅳ级不良事件定义为SAE。围手术期定义为CRS+HIPEC治疗日至术后30 d。OS定义为CRS+HIPEC手术当日至死亡或末次随访时间,采用Kaplan-Meier法进行生存结果描述,组间比较采用Log-rank检验。影响生存的独立预后因素则采用Cox比例风险回归模型单因素和多因素分析。结果全组患者中男529例(38.2%),中位年龄55(10~87)岁,中位体质指数为22.6 kg/m²。1384例腹膜癌患者中来源于胃癌164例(11.8%),结直肠癌287例(20.7%),腹膜假黏液瘤356例(25.7%),腹膜恶性间皮瘤90例(6.5%),卵巢癌、宫颈癌、子宫内膜癌及原发性腹膜癌等共计300例(21.7%),腹膜后肉瘤、肺癌、乳腺癌等少见来源肿瘤187例(13.5%)。本组患者中位手术时间595(90~1170)min,中位脏器切除数2(0~10)个,中位腹膜切除区域数4(0~9)个,中位腹膜癌指数(PCI)评分21(1~39)分,细胞减灭程度(CC)评分0~1分达61.9%(857/1384)。HIPEC方案:顺铂+多西他赛917例(66.3%)、顺铂+丝裂霉素183例(13.2%)、阿霉素+异环磷酰胺43例(3.1%)及其他方案240例(17.3%)。331例(23.9%)腹膜癌患者发生围手术期严重不良事件500例次,其中21例(1.5%)患者因治疗无效于围手术期内死亡,其余患者经积极治疗后痊愈。全组患者中位随访时间为8.6(0.3~182.7)个月,414例(29.9%)死亡,mOS为38.2个月(95%CI:30.6~45.8),1、3、5年生存率分别为73.5%、50.4%、39.3%。其中,胃癌腹膜转移、结直肠癌腹膜转移、腹膜假黏液瘤、恶性腹膜间皮瘤和妇科肿瘤及原发性腹膜癌患者mOS分别为11.3个月(95%CI:8.9~13.8)、18.1个月(95%CI:13.5~22.6)、59.7个月(95%CI:48.0~71.4)、19.5个月(95%CI:6.0~33.0)和51.7个月(95%CI:14.6~88.8),组间比较差异有统计学意义(P<0.001)。Cox单因素和多因素分析显示,原发肿瘤为胃癌(HR=4.639,95%CI:1.692~12.724)、结直肠癌(HR=4.292,95%CI:1.957~9.420)和恶性腹膜间皮瘤(HR=2.741,95%CI:1.162~6.466);卡氏功能状态(KPS)评分为60分(HR=4.606,95%CI:2.144~9.895)、70分(HR=3.434,95%CI:1.977~5.965);CC评分为1分(HR=2.683,95%CI:1.440~4.999)、2~3分(HR=3.661,95%CI:1.956~6.852)以及围手术期发生SAE(HR=2.588,95%CI:1.846~3.629)均是影响本组腹膜癌患者生存的独立危险因素,差异均有统计学意义(均P<0.05)。结论CRS+HIPEC是针对腹膜癌有效的整合治疗技术,可延长生存,围手术期安全性可接受。术前需要严格筛选病例,KPS评分<80分者应慎重选择接受CRS+HIPEC治疗;术中应在保证安全的前提下,努力达到满意细胞减灭程度;另还要应积极预防围手术期SAE以降低腹膜癌患者死亡风险。     

恒温腹腔热灌注化疗治疗结直肠癌并恶性腹水临床疗效观察

【摘要】目的 探讨恒温腹腔热灌注化疗对结直肠癌并恶性腹水的临床疗效。方法 42例结直肠癌并腹水患者行肿瘤切除术后,使用BR-TRG-Ⅰ型体腔热灌注治疗系统进行腹腔恒温热灌注化疗,水温恒定保持在42±0.5℃,化疗液为生理盐水3000ml＋5-FU 2.0,灌注时间为60分钟。结果 42例患者均顺利完成热灌注化疗,未发生需要终止治疗的严重不良反应,其中腹水完全缓解24例（57.15%）,部分缓解12例（28.57%）,稳定4例（9.52%）,无效2例（4.76%）,有效率达到85.71%。结论 恒温腹腔热灌注化疗是治疗结直肠癌并恶性腹水的有效方法。     

Malignant ascites: A review of prognostic factors, pathophysiology and therapeutic measures

Malignant ascites indicates the presence of malignant cells in the peritoneal cavity and is a grave prognostic sign. While survival in this patient population is poor, averaging about 20 wk from time of diagnosis, quality of life can be improved through palliative procedures. Selecting the appropriate treatment modality remains a careful process, which should take into account potential risks and benefits and the life expectancy of the patient. Traditional therapies, including paracentesis, peritoneovenous shunt placement and diuretics, are successful and effective in varying degrees. After careful review of the patient’s primary tumor origin, tumor biology, tumor stage, patient performance status and comorbidities, surgical debulking and intraperitoneal chemotherapy should be considered if the benefit of therapy outweighs the risk of operation because survival curves can be extended and palliation of symptomatic malignant ascites can be achieved in select patients. In patients with peritoneal carcinomatosis who do not qualify for surgical cytoreduction but suffer from the effects of malignant ascites, intraperitoneal chemotherapy can be safely and effectively administered via laparoscopic techniques. Short operative times, short hospital stays, low complication rates and ultimately symptomatic relief are the advantages of laparoscopically administering heated intraperitoneal chemotherapy, making it not only a valuable treatment modality but also the most successful treatment modality for achieving palliative cure of malignant ascites.     

Carcinomatosis peritoneal tras nefrectomía parcial laparoscópica en carcinoma de células renales: nuestra experiencia y revisión de la literatura

ObjectivePeritoneal carcinomatosis associated with renal cell carcinoma is an infrequent entity, usually associated with large renal masses, and with a very rare presentation after surgery of localized renal tumors. Our objective is to review the literature and analyze the factors involved in the development of peritoneal carcinomatosis after laparoscopic partial nephrectomy in localized tumors.Material and methodsWe present our experience with two cases of peritoneal carcinomatosis after laparoscopic partial nephrectomy. We reviewed the literature and analyzed the factors associated with the development of peritoneal carcinomatosis after laparoscopic partial surgery in renal cell carcinoma.ResultsBetween 2005-2018, 225 patients underwent laparoscopic partial nephrectomy for localized renal neoplasia in our service. Two patients developed peritoneal carcinomatosis during follow-up, at 1.5 and 7 years after surgery. Few cases of postoperative peritoneal carcinomatosis for renal neoplasia have been described in the literature, being more frequently associated with large renal masses, with multiple metastases at diagnosis, with a poor prognosis. The dissemination of tumor cells during surgery, direct tumor extension or metastasis by hematogenous route, are among the factors involved in the development of this condition.ConclusionsPeritoneal carcinomatosis after laparoscopic partial nephrectomy constitutes a very rare event. However, it should be taken into consideration, and, since it is the only factor we can influence, we must maximize precautions during the surgical act, following oncological principles.     

腹腔镜下非边缘部位小肝癌切除34例临床分析

目的探讨腹腔镜肝切除术在治疗非边缘部位小肝癌中的临床应用价值。方法对笔者所在医院2008年3月至2011年4月期间34例行腹腔镜肝切除术的非边缘部位小肝癌患者的临床资料进行回顾性分析。结果 34例患者中32例在不阻断肝血流情况下完成腹腔镜肝切除术,2例中转开腹。手术时间为(162±65)min(100～220 min),术中出血量为(295±166)ml(100～750 ml)。术后并发肝创面出血2例、腹水2例,无胆瘘、感染、CO2气栓等并发症发生,无围手术期死亡病例。术后住院时间为(6±2)d(4～9 d)。术后随访(23±7)个月(5～42个月),13例出现肝内非原位复发,术后1年生存率为90.6%(29/32),无瘤生存率为75.0%(24/32)。结论腹腔镜肝切除对部分非边缘部位小肝癌是一种安全有效的微创治疗方法,可考虑作为肝癌治疗的选择术式之一。     

Peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemohyperthermia

STUDY AIM: The aim of this prospective non-randomized trial was to report a series of intraperitoneal carcinomatosis due to miscellaneous causes, treated by intraperitoneal hyperthermic perfusion (IPHP) and cytoreductive surgery. PATIENTS AND METHOD: From January 1995 to May 1999, 35 patients were treated by IPHP and 26 of them underwent maximal cytoreductive surgery. IPHP was performed for 60 minutes at an intraperitoneal temperature of 42 degrees C with Mitomycin C (10 mg/L) or cisplatinum (12 mg/L) at a flow rate of 0.9 L/min. RESULTS: There was one (2.8%) postoperative death due to respiratory complications on day 16. Three patients (8.5%) were admitted to the intensive care unit. A high morbidity rate (54%) was observed with intra-abdominal complications in 28.5% of patients, requiring reoperation in three patients. In patients with stages 1 and 2 peritoneal carcinomatosis (granulations less than 5 mm), the 12- and 24-month survival rates were 63.1% and 31.5%, respectively. In patients with advanced stage 3 (diffuse malignant nodules less than 2 cm) and stage 4 carcinomatosis (malignant nodules larger than 2 cm), the 12- and 24-month survival rates were 31.2% and 12%, respectively. Six patients survived for more than 30 months. CONCLUSION: IPHP appears to be an effective treatment for peritoneal carcinomatosis. IPHP combined with cytoreductive surgery is aggressive with a high morbidity rate. Rigorous patient selection is necessary. IPHP is still under evaluation. Prospective randomized trials with identical IPHP protocols are required.     

化疗联合腹腔灌注细胞因子诱导的杀伤细胞治疗胃癌腹水

目的评价化疗联合腹腔灌注细胞因子诱导的杀伤细胞（CIK）过继免疫治疗胃癌腹水的疗效和安全性。方法将2008年1月至2010年12月间复旦大学附属中山医院收治的伴有明显腹水的42例晚期胃癌患者,根据患者个人意愿分为单纯化疗组（22例,希罗达加奥沙利铂的XELOX方案）和联合治疗组（20例,XELOX方案化疗联合腹腔灌注CIK）。比较两组患者临床疗效、不良反应及免疫功能。结果与单纯化疗组相比,治疗后联合治疗组患者Karnofsky评分明显更高（78．0±9．8比70．0±8．9,P=0．009）,两个周期内的腹水引流量明显减少[（4500±1218）ml比（5527±1460）ml,P=0．018],中位疾病进展时间延长（4．0个月比2．5个月,P=0．006）,中位总生存时间延长（11．0个月比6．0个月,P=0．001）,CD4^＋／CD8^＋比值升高（1．34±0．36比0．96±0．26,P=0．001）,但疾病反应率（35．0％比22．7％,P=0．499）和疾病控制率（75．0％比54．5％。P=0．209）均未见明显增高。两组患者治疗过程均未见明显不良反应。结论与单纯化疗相比,化疗联合CIK免疫治疗对胃癌腹水患者疗效更好,不仅可延长生存期,提高免疫功能,而且具有较好的安全性。