膀胱热灌注化疗与普通膀胱灌注化疗患者的生命质量比较

目的 比较膀胱热灌注化疗与普通膀胱灌注化疗患者的生命质量.方法 采用欧洲癌症研究与治疗组织生命质量核心量表EORTC QLQ-C30 V3.0及非肌层浸润性膀胱癌(NMIBC)患者生命质量特异性模块QLQ-NMIBC 24,分别于膀胱肿瘤电切术(TURBT)前与膀胱诱导灌注治疗后评价2组共132例中高危NMIBC患者的...     

丝裂霉素膀胱灌注热化疗治疗T1G3膀胱尿路上皮癌的疗效分析

目的:探讨丝裂霉素膀胱灌注热化疗治疗T_1G_3膀胱尿路上皮癌的疗效及安全性。方法:76例原发性或复发性T_1G_3膀胱尿路上皮癌患者,均行经尿道膀胱肿瘤电切术,40例患者术后接受单独丝裂霉素进行膀胱灌注治疗,36例患者接受术后予丝裂霉素进行膀胱灌注热化疗。随访时间24个月。分析两种治疗方法的无复发生存期和无进展生存期。结果:在76例患者中,单纯膀胱灌注化疗组肿瘤复发率及进展率分别为35%及22.5%,膀胱灌注热化疗组复发率及进展率分别为13.9%和5.6%。两组比较差异有统计学意义。(P=0.034及P=0.036)。Kaplan-Meier分析显示两种治疗方法无复发生存率及无进展生存率差异有统计学意义(P=0.027及P=0.047)。结论:T_1G_3膀胱尿路上皮癌TURBT术后予MMC膀胱灌注热化疗治疗是安全,有效的。能有效降低T_1G_3膀胱尿路上皮癌术后复发和肿瘤进展风险。     

羟基喜树碱膀胱灌注化疗联合体外热电场热疗预防浅表性膀胱癌复发的临床研究

目的探讨羟基喜树碱(HCPT)膀胱内灌注化疗联合体外热电场热疗预防浅表性膀胱癌复发的疗效及安全性。方法 83例原发性或复发性浅表性膀胱移形上皮细胞癌患者,均行经尿道膀胱肿瘤电切术(TURBT),术后随机分配到疗法1组及疗法2组,疗法1组为羟基喜树碱膀胱内灌注化疗联合体外热场热疗(42例),疗法2组为单独应用羟基喜树碱膀胱内灌注化疗(41例)。本研究的有效性评估终点是无复发生存率及复发概率的估计评价(应用Kaplan-Meier分析及Log-rank检验)。最小随访时间为24个月。安全评价包括主观和客观的副作用和并症发。结果在随机分配的83例患者中,76例坚持完成研究并进行有效的统计分析。其中疗法1组39例6例复发(15.4%),疗法2组37例,14例复发(37.8%)。两种治疗法经Log-rank检验显示其无复发生存率有显著性差异(P=0.017),疗法2组的复发率高于疗法1组(P=0.03)。结论羟基喜树碱膀胱内灌注化疗联合体外热电场热疗效果明显优于单独应用羟基喜树碱膀胱内灌注化疗,患者耐受性良好,安全可行。     

非肌层浸润性膀胱癌热灌注化疗有效性和安全性的Meta分析

目的 系统评价热灌注化疗(HIVEC)治疗非肌层浸润性膀胱癌(NMIBC)的有效性和安全性。方法 检索Pub Med、Embase、Cochrane Library、Web of Science、CNKI、VIP、万方及CBMDisc数据库,检索时间均截止到2022年3月,由2名研究者独立筛选文献,收集NMIBC行经尿道膀胱肿瘤电切术后接受HIVEC治疗的随机对照或临床对照试验,分析其有效性和安全性,应用Rev Man 5.3软件进行Meta分析。结果 共纳入17篇文献,包含1 599例患者。Meta分析显示,HIVEC治疗后12个月复发率[RR=0.35,95%CI(0.24,0.51),P<0.000 01]和24个月复发率[RR=0.41,95%CI(0.33,0.50),P<0.000 01]均低于常规灌注化疗;HIVEC与常规灌注化疗的不良反应发生率差异无统计学意义[RR=0.86,95%CI(0.62,1.19),P=0.37]。结论 现有研究表明HIVEC能够降低NMIBC患者的肿瘤复发率,增强抗肿瘤效果。     

向日葵花粉微胶囊作为药物载体用于膀胱癌膀胱灌注化疗的研究题录

目的探究向日葵花粉微胶囊作为膀胱灌注药物载体的安全性以及有效性。方法天然向日葵花粉经脱脂、空心化、涂覆海藻酸盐等处理后最终制备出向日葵花粉微胶囊, 使用扫描电子显微镜观察花粉的形态特征。体外实验中将小鼠膀胱癌MB49细胞分为花粉共培养组与对照组, 使用细胞计数试剂盒(CCK-8)试验测定细胞活力, 并使用酶联免疫吸附试验(ELISA)检测细胞分泌的细胞因子变化。使用异硫氰酸荧光素-牛血清白蛋白(FITC-BSA)作为模拟药物装载进入花粉, 测试花粉微胶囊的缓释效果。体内实验选用BALB/c-Nu裸鼠用MB49细胞建立原位膀胱癌模型, 用吉西他滨或花粉微胶囊装载吉西他滨进行膀胱灌注化疗, 观察治疗效果。两组间差异比较采用单样本t检验。结果 CCK-8试验结果表示花粉在不同的浓度与时间上对MB49细胞没有显著细胞毒性(P>0.05);ELISA实验结果显示花粉微胶囊促进MB49细胞细胞因子[白细胞介素(IL)-2(1.230±0.208) pg/ml比(0.670±0.208) pg/ml(t=3.297, P<0.05);IL-6(2 027.00±64.29) pg/ml比(1 550.00±70.00) pg/ml(t=8.693, P<0.05);IL-8(26.330±1.528) ng/ml比(22.900±1.054) ng/ml(t=3.200, P<0.05);肿瘤坏死因子-α(TNF-α)(99.670±3.512) pg/ml比(75.670±7.024) pg/ml, t=5.293, P<0.05]分泌, 而海藻酸钠涂层减弱这一作用[IL-2(0.830±0.153) pg/ml比(1.230±0.208) pg/ml(t=3.354, P<0.05);IL-6(1 770.00±62.45) pg/ml比(2 027.00±64.29) pg/ml(t=4.966, P<0.05);IL-8(27.700±1.852) ng/ml比(26.330±1.528) ng/ml(t=0.990, P>0.05);TNF-α(88.670±8.505) pg/ml比(99.670±3.512) pg/ml, t=3.200, P<0.05]。药物释放曲线显示海藻酸盐涂层显著延长向日葵花粉微胶囊的药物释放时间[80%(600 min比5 min), t=70.730, P<0.05]。体内实验结果证实, 向日葵花粉组小鼠膀胱肿瘤病变数量显著低于直接灌注组(2.20±0.83比5.60±1.14, t=4.176, P<0.05)。结论本研究证明天然向日葵花粉粒在膀胱癌膀胱灌注疗法中作为药物输送载体具有良好的安全性和有效性, 是膀胱灌注中一种有希望的新材料。     

抗肿瘤药物膀胱灌注的研究进展

抗肿瘤药物膀胱灌注是预防和治疗浅表性膀胱癌的重要手段。膀胱灌注的理想抗肿瘤药物最好是：价廉，全身吸收和局部毒性极少，且能有效防止原发灶切除后肿瘤的复发和进展或根治不易完全切除的病灶。但目前各种灌注治疗药物大都存在着长期疗效不肯定、副作用发生率高甚至有可能出现一些不可预测的严重并发症等缺点。寻求更有效的抗肿瘤药物、更合适的灌注治疗方案以及最佳的给药方法成为目前的研究热点。     

免疫毒素膀胱灌注预防膀胱癌复发的临床研究

目的 评价免疫毒素在预防膀胱癌复发中的价值。方法 用免疫组化ＳＰ法检测抗人膀胱癌单克隆抗体（ＢＤＩ－Ｉ）与蓖麻毒素（ＲＴ）偶联制备的免疫毒素（ＢＤＩ－１－ＲＴ）与３８例不同分级分期膀胱移行细胞癌组织标本的结合活性。膀胱移行细胞癌患者术后３１例膀胱灌注ＢＤ－１－ＲＴ为实验组,３６例使用丝裂霉素Ｃ为对照组,观察二组疗效及副作用。以ＥＬＩＳＡ法检测实验组７例人抗鼠抗体（ＨＡＭＡ）。结果 ３１例（８２％）     

经皮体腔热灌注化疗手术配合体会

目的探讨经皮体腔热灌注化疗治疗盆腹腔恶性肿瘤中的护理配合。方法对40例接受经皮体腔热灌注化疗的盆腹腔恶性肿瘤患者,术中实施护理配合。回顾性分析患者的临床资料。结果 40例患者顺利完成手术并达到满意的临床疗效。结论实施护理配合,可提高经皮体腔热灌注化疗的效果,提升了治疗的安全性和护理质量,值得进一步完善、推广。     

卡介苗膀胱灌注后的全身严重反应：附2例报告

报告2例卡介苗膀胱内灌注防治膀胱癌时发生的全身严重合并症,其中结核感染血行扩散1例,结核性肝炎1例,并就其发病情况、因素、预防与治疗进行讨论。     

膀胱灌注化疗预防输尿管尿路上皮细胞癌术后再发膀胱癌

目的 探讨膀胱灌注化疗对不同级别输尿管尿路上皮细胞癌患者行肾、输尿管及膀胱袖状切除术后再发膀胱癌的影响.方法 对194例原发性输尿管尿路上皮癌患者的临床资料进行回顾性研究,比较术后2年内各级别肿瘤患者中吡柔比星灌注组与未灌注组的膀胱癌复发率.结果 行根治性肾、输尿管及膀胱袖状切除术2年后,灌注组复发率23.9%(28/117)明显低于未灌注组的39.0%(30/77),差异有统计学意义(P＜0.05).其中G1肿瘤灌注患者复发率为5.0%(1/20),未灌注患者复发率14.3%(3/21),差异无统计学意义(P＞0.05);G2肿瘤灌注患者复发率21.4%(12/56)明显低于未灌注组的43.9%(18/41)(P＜0.05);G3肿瘤灌注患者复发率36.6%(15/41),未灌注患者复发率60.0%(9/15),差异无统计学意义(P＞0.05).结论 对于原发性输尿管尿路上皮癌患者,术后膀胱灌注化疗可预防输尿管尿路上皮癌患者术后膀胱癌的发生.尤其对G2肿瘤患者,术后膀胱灌注化疗可有效预防肿瘤的膀胱内复发;但其对G1及G3肿瘤患者无明显预防作用.     

胸腔持续灌注热化疗治疗癌性胸水

目的:研究胸腔持续灌注热化疗对癌性胸水的综合疗效及对机体免疫功能的影响.方法:对21例癌性胸水患者置胸管,向胸水中加入化疗药物顺铂200～250 mg/m2,保持胸水温度42～45℃,持续灌注60 min左右..结果:胸水控制有效率95.2%(CR 90.4% PR4.8%),平均胸水消失持续时间12.5个月,有5例肺部肿块缩小,2例发生远处转移死亡.中位存活期13.7个月.热化疗前、后CD 19、CD 25的表达率明显增高.结论:胸腔持续灌注热化疗使癌性胸水缓解率明显提高,使B淋巴细胞免疫功能及T淋巴细胞活化率明显提高.     

腹腔热灌注化疗毒副作用的观察及分析

目的观察腹腔热灌注化疗(CHPPC)患者治疗期间不良反应的发生情况。方法采用B超引导下行腹腔穿刺置管术,穿刺置管后连接体腔热灌注仪进行灌注治疗,温度控制在42～44℃,循环时间1h,观察患者体温、心率、血压、血氧饱和度及呼吸频率的变化,同时观察患者腹部及全身情况,如腹部压痛、反跳痛等症状及体征。结果本组109例腹盆腔恶性肿瘤患者术后1个月行CHPPC,灌注过程中体温、心率、血压、血氧饱和度及呼吸频率变化与灌注前比较,差异均无统计学意义(P0.05)。有25例患者出现腹痛,但仅3例患者出现类似急腹症表现;26例患者出现消化道反应;20例患者出现骨髓抑制;其他不良反应(22例)主要为穿刺处疼痛,给予对症治疗后缓解。结论CHPPC选择在手术后1个月时进行,毒副作用小,耐受性较好。     

膀胱癌TURBT术后吉西他滨膀胱热灌注临床疗效分析

目的探讨膀胱癌行经尿道膀胱肿瘤电切术(TURBT)后行吉西他滨膀胱热灌注治疗的临床疗效。方法选择2015年2月~2017年2月我院收治的膀胱尿路上皮细胞癌患者60例,随机分为两组,各30例:观察组行45℃吉西他滨热灌注治疗,对照组行吉西他滨常规膀胱灌注治疗。两组治疗持续时间和化疗方案一致。比较两组患者治疗前后血清可溶性细胞间黏附分子-1(sICAM-1)、血清前梯度蛋白2(AGR2)水平,远期生存率、复发及不良反应情况。结果灌注治疗后两组患者sICAM-1和AGR2水平均较灌注前显著下降(P<0.05),且观察组sICAM-1和AGR2水平低于对照组(P<0.05)。观察组2年总复发率和非原位复发率分别为13.33%和3.33%,低于对照组的36.67%和26.67%(P均<0.05);观察组2年无复发生存期平均(22.43±3.41)个月,较对照组(19.04±3.12)个月延长(P<0.05)。两组不良反应率比较无统计学差异(P>0.05)。结论吉西他滨膀胱热灌注治疗可有效降低膀胱癌患者血清sICAM-1和AGR2水平,预后好,能降低TURBT术后复发率,延长生存期,且安全性与常规灌注治疗相近,其治疗膀胱癌的临床前景可期。     

胸腔内循环高温灌注化疗对恶性胸腔积液的作用

目的:总结胸腔内循环高温灌注化学治疗对恶性胸腔积液的作用及优点。方法:对40例恶性胸腔积液的患者,在全身麻醉胸腔镜下用体外循环机将43℃恒温液(生理盐水3000mL、顺铂300mg)持续灌注胸腔1h。结果:患者胸闷、气急等症状消失,胸水控制,KPS评分均在70分以上,毒副作用能耐受。胸水中CEA、CYFRA21-1、NSE浓度较治疗前明显下降(P<0.05),镜下观察胸膜癌结节中癌细胞大量坏死,电镜下可见染色质浓缩、凋亡小体形成,最终核碎裂、肿瘤细胞死亡。结论:胸腔内循环高温灌注化疗对恶性胸腔积液有较好的治疗作用,不良反应轻微,微创,对年老体弱患者也适用。     

Treatment of Primary Peritoneal Mesothelioma by Continuous Hyperthermic Peritoneal Perfusion (CHPP)

Background: Primary peritoneal mesothelioma is a locally aggressive disease that is difficult to treat or even palliate. Continuous hyperthermic peritoneal perfusion (CHPP) with cisplatin (CDDP) allows uniform, high regional delivery of chemotherapeutics and hyperthermia to the peritoneal surface for the treatment of peritoneal tumors. This article summarizes the results of 18 patients with peritoneal mesothelioma treated with CHPP.Methods: From June 1993 through April 1998, 18 patients with primary peritoneal mesothelioma (13 male, 5 female; median age, 51 years) underwent surgical exploration and tumor debulking followed by a 90-minute CHPP with CDDP and hyperthermia as part of three consecutive phase I trials conducted at the National Cancer Institute. Seventeen of 18 patients had malignant peritoneal mesothelioma, 13 with associated ascites. One patient had a symptomatic, multiply recurrent, benign, cystic peritoneal mesothelioma. Three patients who had a recurrence after a prolonged progression-free interval (>6 months) after CHPP underwent re-treatment. CHPP parameters included median cisplatin dose of 530 mg (range, 187–816), perfusate volume 6.0 liter (range, 4–9), flow 1.5 liter/min (range, 1–2), intraperitoneal temperature 41°C (range, 38.7–43.2), and central temperature 38.6°C (range, 36.8–39.7).Results: Median follow-up after CHPP is 19 months (range, 2–56) with no operative or treatment-related mortality. Overall operative morbidity was 24% and included two patients with superficial wound infection and one patient each with atrial fibrillation, pancreatitis, fascial dehiscence, ileus, line sepsis, and clostridium difficile colitis. The major treatment-related toxicity was systemic renal toxicity at doses above what was defined as the maximum tolerated dose of cisplatin. Nine of 10 patients had resolution of their ascites postoperatively. Three patients who developed recurrent ascites (27, 22, and 10 months after initial treatment) were re-treated and had resolution of their ascites with ongoing responses at 24, 6, and 4 months after the second perfusion. The median progression-free survival was 26 months, and the overall 2-year survival was 80%. The median overall survival has not been reached.Conclusions: CHPP with cisplatin can be performed safely with no mortality and minimal morbidity. In selected patients, successful palliation in the abdomen and long-term survival, compared with historical controls, can be achieved with aggressive surgical debulking and CHPP. Re-treatment after initial response can result in a second long-term response.     

肺隔离高温药物灌注治疗肺癌(附14例报告)

游离阻断１４例中、晚期肺癌病人的单侧肺（或肺叶）主要血管，经肺动脉、肺静脉插管与心泵连接，建立与体循环隔离的体外肺循环。在肝素化预充液中加入超量表阿霉素和环磷酰胺，进行高温（４１～４３℃）灌注５０～６０分钟，停机关胸。本组无手术死亡。术后１、２年分别死亡２、５例，生存率分别为８５．７％和５０％，余７例均健在。术后１０～１２个月对肺部残存肿块在ＣＴ定向下穿刺活检均为纤维组织。证明此疗法杀灭肿瘤组织效果确切，对正常肺组织的损伤是轻微且可逆的     

Current Techniques of Hyperthermic Isolated Limb Perfusion for Malignant Melanoma

(Received for publication on Aug. 19, 1998; accepted on Sept. 17, 1999)     

Sclerosing Encapsulating Peritonitis (SEP) as a Delayed Complication of Continuous Hyperthermic Peritoneal Perfusion (CHPP): Report of a Case

A 47-year-old woman underwent curative resection of advanced gastric cancer, followed by continuous hyperthermic peritoneal perfusion (CHPP). She was readmitted to our hospital 6 months after the operation with a diagnosis of postoperative adhesional ileus. An exploratory laparotomy revealed that the small intestine, which had normal serosa, was folded and enveloped in thickened peritoneum like a "cocoon," suggesting sclerosing encapsulating peritonitis (SEP). Because of tight adhesion in the ileocecal region, resection of the membrane was performed only in the feasible areas, followed by side-to-side anastomosis between the ileum and ascending colon. The patient has remained well for 15 months since this operation with no radiological signs or laboratory findings of recurrence. When small bowel obstruction does not show improvement with conservative treatment, and if the possibility of peritoneal cancer recurrence is excluded by thorough examinations, it is important to perform laparotomy early to resolve the symptoms of bowel obstruction and restore the patient's quality of life.     

Peritonectomy and Intraperitoneal Hyperthermic Perfusion (IPHP): A Strategy That Has Confirmed its Efficacy in Patients with Pseudomyxoma Peritonei

Background: Pseudomyxoma peritonei (PMP) is a rare disease with a poor prognosis characterized by a complete redistribution of mucin within the peritoneal cavity. The aim of this multicentric study was to evaluate the survival, morbidity, toxicity, and mortality of patients with PMP treated by cytoreductive surgery (CRS) with intraperitoneal hyperthermic perfusion (IPHP).Methods: Thirty-three patients with PMP (21 males and 12 females) were enrolled in a phase II clinical trial. One patient underwent surgery twice because of disease recurrence. CRS was performed with peritonectomy procedures. The closed abdomen technique was employed for IPHP with use of cisplatin (25 mg/m²/L) plus mitomycin-C (3.3 mg/m²/L) for 60 minutes under hyperthermic conditions (42.5°C).Results: Thirty-one patients (92%) were optimally cytoreduced. Five-year overall survival, progression-free survival, and locoregional progression-free survival rates were 97%, 43%, and 59%, respectively. Grade II and grade III morbidity was observed in 5 patient (15%) and 6 patients (18%), respectively. There was one treatment-related death (3%), 21 days after treatment.Conclusions: CRS associated with IPHP permitted complete tumor removal with an acceptable morbidity and mortality for patients with PMP. This study confirms the efficacy of the combined treatment in terms of long-term survival and local disease control.     

Bowel Complications in 203 Cases of Peritoneal Surface Malignancies Treated With Peritonectomy and Closed-Technique Intraperitoneal Hyperthermic Perfusion

Background Peritonectomy and intraperitoneal hyperthermic perfusion (IPHP) are increasingly used in the management of carcinomatosis of various sites of origin. We analyzed the risk factors for bowel complications with primary anastomoses and the closed technique for IPHP. Methods From 1995 to 2004, 203 consecutive procedures were performed at the National Cancer Institute of Milan. We retrospectively analyzed this series of patients. Treated pathologies included peritoneal mesothelioma; pseudomyxoma peritonei; colorectal, ovarian, or gastric carcinomatosis; and abdominal sarcomatosis. All digestive anastomoses were performed before the IPHP. Only one defunctioning stoma was used. Results We found a bowel complication rate of 10.8%. The bowel complications:anastomoses ratio was 11.3%. On univariate analysis we found a statistically significant association between bowel complications and the following variables: sex, previous systemic chemotherapy status, number of anastomoses ( fewer than two vs. two or more), duration of the procedure (<8.7 vs. ≥8.7 hours), and extent of cytoreduction. After multivariate analysis, male sex (odds ratio [OR], 4.2), no previous systemic chemotherapy (OR, 3.5), and duration of the procedure ≥8.7 hours (OR, 6.3) were considered independent risk factors for bowel complications. Conclusions Bowel complications are not increased when primary unprotected anastomoses are performed during peritonectomy and IPHP when the closed technique is used. Male sex, duration of the procedure, and no previous systemic chemotherapy are independent unfavorable risk factors.