BR-TRG-I型体腔热灌注治疗仪实施膀胱内温热灌注化疗的疗效观察

目的:探讨BR-TRG-I型体腔热灌注治疗仪实施膀胱内温热灌注化疗治疗高复发表浅性膀胱移行细胞癌的效果。方法:选取2011年3月~2014年10月收治的高复发表浅性膀胱移行细胞癌患者90例,随机分为研究组(n=45)和对照组(n=45)。对照组患者术后24小时内行膀胱灌注,研究组患者术后3天行丝裂霉素膀胱腔内热灌注化疗。结果:研究组患者膀胱局部复发率为33.3%(15/45),显著低于对照组的77.8%(35/45)(P0.05);复发时间和复发间期均显著长于对照组(P0.05);复发肿瘤个数显著少于对照组(P0.05)。结论:BR-TRG-I型体腔热灌注治疗仪实施膀胱内温热灌注化疗治疗高复发表浅性膀胱移行细胞癌患者效果显著,值得在临床推广。     

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。     

经尿道膀胱肿瘤电切术后膀胱灌注吡柔比星治疗浅表性膀胱肿瘤42例报告

目的探讨吡柔比星膀胱灌注对治疗浅表性膀胱癌术后复发的预防效果。方法42例患者,在行经尿道膀胱肿瘤电切术（TURBt）术后定期经导尿管给予膀胱内灌注吡柔比星30mg／40ml,每周1次,每次膀胱内保留60min,共8次,术后3个月行1次膀胱镜检查。结果共有4例复发。42例患者有不同程度的膀胱区不适,3例症状较重。结论吡柔比星膀胱内灌注预防肿瘤术后复发疗效显著、安全、可靠。     

膀胱腔内热化疗联合应用预防肿瘤复发疗效观察

目的:降低膀胱移行细胞癌术后复发率,评价热、化疗联合应用的疗效及安全性。方法:对40例膀胱移行细胞癌术后患者,在膀胱腔内局部恒温热盐水持续灌注,每次10000ml,每日一次,10次为一疗程。同时吡柔比星20mg/40ml膀胱腔内灌注,每周一次,连续8次,总用量为160mg。结果:40例患者均获随访。随访时间9～52个月,除1例术后10个月、1例术后30个月复发外,余38例均未见肿瘤复发及转移。复发率为5%。结论:膀胱腔内热化疗联合应用预防移行细胞癌术后复发效果满意,安全性好。     

术中及术后早期腹腔或盆腔热灌注化疗治疗结直肠癌的临床观察

目的:探讨术中和术后早期腹腔或盆腔热灌注化疗治疗结直肠癌的可行性、安全性、毒副作用、并发症和短期抗癌疗效.方法:对住院治疗的20例进展期结直肠癌患者行根治性或姑息性切除后,术中行腹腔热灌注化疗1次,术后4 d每日腹腔热灌注化疗1次,化疗液加热至43～44 ℃,循环灌注60～90 min,共5次;直肠癌患者术中盆腔热灌注化疗1次.结果:术中及术后早期行腹腔或盆腔热灌注化疗成功率为100%,热化疗时间内腹腔内化疗液温度均可达到41～43 ℃,并恒定保持60～90 min.热灌注化疗期间患者生命体征无明显异常,除暂时性发热、腹胀、腹痛外无其它不适,直肠癌患者盆腔少量出血1例,切口愈合延迟1例,无其它明显毒副作用及并发症.随诊率100%,随访3～17个月.其中腹腔转移2例,盆腔转移1例,局部复发率为15%,肝转移1例,肝转移率6.2%;结肠癌、直肠癌患者中各有1例分别在术后14、10个月死于全身广泛转移.结论:围手术期腹腔或盆腔热灌注化疗结直肠癌安全可行,治疗不受环境限制,并可多次进行,毒副作用小,并发症少,可能有利于杀灭腹腔内残余微小癌灶(MC)和游离癌细胞(FCC).     

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...     

吡柔比星膀胱灌注预防浅表性膀胱癌术后复发

目的：评价吡柔比星（THP）膀胱内灌注预防浅表性膀胱癌术后复发的近期疗效。方法：对34例浅表性膀胱癌患者行经尿道膀胱肿瘤电切术（TURBt)或膀胱部分切除术，术后定期用THP（30mg/40ml）作膀胱内灌注，每周1次共8次，以后每月1次共1年。每次药物在膀胱内保留40min。结果：经10－12个月随访，无肿瘤复发32例，复发2例，复发率为5．9％；未见全身性药物不良反应，仅5例患者出现轻度膀胱刺激症状。结论：THP膀胱内灌注预防浅表性膀胱癌术后得发近期疗效满意，副作用轻，耐受性良好。     

腹腔热灌注化疗对患者生命体征的影响

目的探讨腹腔热灌注化疗对患者生命体征的影响,为评估该种治疗方法临床应用的安全性提供依据。方法对收治的20例恶性肿瘤患者进行腹腔热灌注化疗,治疗温度43℃,时间60 min,灌注速度500 mL/min。监测患者治疗前及治疗术中15,30,45,60 min各时点进水口、出水口及患者体表、直肠、鼓膜的温度;监测各相应时点的血压、心率、呼吸、血氧饱和度;分析该疗法对患者体生命体征的影响。结果腹腔热灌注化疗前至治疗60 min结束时患者的腋窝、鼓膜、直肠温度平均分别上升了0.9℃,0.7℃和0.9℃;治疗过程中各时点血压、心率、呼吸、血氧饱和度等数值均在正常范围内,治疗前及治疗过程中无明显变化。结论以43℃的治疗温度,500 mL/min的灌注速度进行腹腔热灌注化疗60 min,可引起体温轻微升高,但对各重要生命体征无明显影响。腹腔热灌注化疗对机体生理影响轻微,临床应用安全可靠。     

保留膀胱综合方法治疗肌层浸润性膀胱癌的疗效评价

目的探索保留膀胱手术＋膀胱内灌注化疗＋动脉灌注化疗治疗浸润性膀胱癌的临床疗效。方法 2003年5月至2012年2月,对经尿道膀胱肿瘤电切或膀胱部分切除后确诊为肌层浸润性膀胱癌（T2N0M0）的56例保留膀胱的患者,给予动脉灌注化疗加膀胱灌注化疗。结果 56例患者均获得随访,随访6～98个月,平均（36.0±3.2）个月,53例（94.6%）患者无复发及转移,3例（5.4%）分别在术后6、8、12复发,复发患者均给于全膀胱切除术,无死亡病例,没有明显并发症。结论保留膀胱手术后确诊的肌层浸润性膀胱癌患者,采用经髂内动脉灌注化疗＋膀胱内灌注化疗的联合治疗方法,能有效减少肿瘤复发,显著降低静脉化疗的副作用,提高患者的生活质量,患者易于接受,值得进一步探讨。     

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。     

进展期胃癌术中腹腔热灌注化疗的效果分析

目的:分析进展期胃癌术中腹腔热灌注化疗的效果。方法:选取94例接受胃癌根治术的患者,按照随机数字表分为观察组及对照组,各47例,观察组接受术中腹腔热灌注化疗,对照组仅接受单纯根治性手术,对比两组患者的疗效和并发症情况。结果:观察组CR 8例,PR 26例,有效率72.3%;对照组CR 3例,PR 15例,有效率38.3%,观察组有效率显著高于对照组(P0.05)。2组患者术后均出现血液指标异常、发热、血压下降、心率上升及其他并发症,均经对症处理后在7 d内恢复正常,其各项指标异常、并发症发生率无明显统计学差异(P0.05)。观察组患者1年、2年及3年存活率分别为85.1%、57.4%及29.8%,均显著高于对照组(P0.05)。结论:进展期胃癌术中腹腔热灌注化疗较传统胃癌根治术具有更好的疗效,且无明显不良反应,疗效及安全性均可靠。     

胃肠道肿瘤术中温热灌洗化疗及术后动脉灌注化疗的临床研究

目的 探讨胃肠道癌术后预防腹腔转移及肝转移的方法。方法 对132例胃肠道癌切除术后病人随机分成术中腹腔温热灌洗及术后动脉灌注化疗组69例(简称治疗组)，单纯静脉化疗组63例(简称对照组)，并对其腹腔转移率、肝转移率及3年生存率进行对照研究。结果 治疗组腹腔转移率20．9％、肝脏转移率13．4％、3年生存率74．6％，对照组腹腔转移率43．8％、肝脏转移率29．4％、3年生存率49．5％。结论 术中腹腔温热灌洗及术后动脉灌注化疗对胃肠道癌病人术后腹腔转移及肝转移有良好的防治作用。     

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。     

胃癌术后腹腔热灌注联合静脉化疗的应用研究

目的研究胃癌术后腹腔热灌注化疗联合静脉化疗的治疗效果。方法140例胃癌根治术后患者随机分为腹腔热灌注组(n=72)和静脉化疗组(n=68)。腹腔热灌注组患者在静脉化疗同时应用腹腔热灌注化疗,观察两组术后并发症、不良反应、术后生存率及腹腔复发率。结果两组在术后并发症及不良反应无显著性差异。术后3、5年生存率腹腔热灌注组和静脉化疗组分别为86.1%、60.2%和58.3%、29.4%(P<0.05);术后3、5年腹腔复发率分别为5.6%、27.8%和20.6%、53%(P<0.05)。结论胃癌术后腹腔热灌注联合静脉化疗可有效控制复发和转移,提高胃癌术后病人的生存率和生存质量。     

High-Dose Mitomycin C in Isolated Hyperthermic Liver Perfusion for Unresectable Liver Metastases

In order to reduce systemic side effects and increase intrahepatic mitomycin C (MMC) concentrations, isolated hyperthermic liver perfusion (IHLP) has been performed using MMC. This article describes the pharmacokinetics of MMC in IHLP and presents our clinical experience with its use in six patients suffering from unresectable liver metastases. Primary tumors consisted of colorectal carcinomas in three cases, breast cancer in two, and a choroidal melanoma in one. Dosages of MMC varied between 0.5 and 1.0 mg MMC/kg body weight. MMC was added as a bolus directly into the extracorporeal circuit. Intrahepatic temperature was elevated to 40.0-41.0°C by hyperthermic perfusion. MMC concentrations were measured in peripheral blood (preperfusion, then at 5, 30, and 55 min during perfusion, and finally at 5 and 60 min and 6 and 24 h after perfusion) and in recirculating perfusate (5, 30, and 55 min). While markedly elevated MMC concentrations (maximum 6290 ng/mL) were found in the liver perfusate, systemic concentrations remained low (maximum 45 ng/mL), indicating no considerable leakage. MMC concentrations in the perfusate constantly decreased during perfusion. After rinsing with 1500 mL saline, a mean concentration of 52.5 f 33 ng MMC/mL was measured in the washout from 5 patients. In 1 patient with a colorectal carcinoma, MMC concentrations in the perfusion medium were 10-fold and in the plasma 2-fold higher than in the other patients. This high MMC concentration caused severe intrahepatic vascular damage and finally led to the patient's death. In conclusion, IHLP and intrahepatic perfusion with MMC resulted in a high response of hepatic tumors. Systemic exposure of MMC can be reduced effectively by isolated perfusion. However, hepatic toxicity of MMC must be considered.     

Anaesthesia for intra-peritoneal perfusion of hyperthermic chemotherapy Haemodynamic changes, oxygen consumption and delivery

We investigated the intra-operative application of intraperitoneal perfusion of hyperthermic chemotherapy and its effects on cardiovascular status and oxygen consumption and delivery in 11 patients following laparotomy for surgical resection of recurrent tumours or peritoneal metastases. Closed peritoneal irrigation was carried out with perfusate at a temperature of 45–47°C. External cooling was applied during the procedure to prevent systemic hyperthermia. Data were collected 5 min before the commencement of the hyperthermic peritoneal perfusion, at 5, 30, 60 and 90 mm during perfusion and 5 min after perfusion was discontinued. During the hyperthermic perfusion period, the core body temperature increased significantly but remained within clinically acceptable values. Heart rate, central venous pressure and pulmonary artery pressure increased significantly during perfusion; these returned to control values immediately after discontinuation of perfusion, except for the heart rate, which remained high. Mean arterial pressure, cardiac output, oxygen delivery and oxygen consumption did not change significantly although a metabolic acidosis developed during the study period. These findings suggest that the intraperitoneal perfusion of hyperthermic chemotherapy may be safe in humans, provided that appropriate monitoring, cooling and technical support are applied.     

新辅助介入化疗联合微创手术治疗浸润性膀胱癌

目的 探讨新辅助介入化疗联合腔内手术治疗浸润性膀胱癌的临床效果.方法 对31例确诊为肌层浸润性膀胱癌（T2~4/G1~3）的患者行新辅助性介入化疗,先经股动脉入髂内动脉,尽可能到达供应肿瘤血管,给予丝裂霉素10 mg,吉西他宾1.0/m2,顺铂90 mg,明胶海绵暂时性封堵后拔管,1周后行经尿道膀胱肿瘤汽化电切术,术后即刻用丝裂霉素200 mg或吡柔比星40 mg膀胱灌注.结果 21例治疗1次,7例治疗2次（间隔1个月）,3例治疗3次（间隔1~2个月）.31例随访4个月~4年,平均36个月,2例术后6、10个月复发,再次重复治疗,1例因盆腔转移治疗2次后拒绝治疗,半年后死于肺转移,其余未见肿瘤复发.结论 对于局限浸润性膀胱癌的患者,采用新辅助性经髂内动脉插管介入化疗联合腔内手术治疗疗效满意.     

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.     

肝切除联合腹腔热灌注化疗在肝癌自发破裂出血中的应用

目的探讨肝切除联合腹腔热灌注化疗在肝癌自发破裂出血中的应用价值。方法回顾性分析2013年1月至2016年10月在中山市人民医院行肝切除联合腹腔热灌注化疗的20例肝癌自发破裂出血患者的临床资料。统计和分析患者的手术时间、术中出血量、术后并发症、术后住院时间及随访情况。结果患者均顺利完成手术,肿瘤切除后切缘均为阴性,患者无围手术期死亡。手术时间为(204±45)min;术中出血量为100~800 m L,平均270 m L;术后住院时间为(11±4)d。术后发生胸腔积液及腹腔积液各2例,经保守治疗治愈。1例于术后3个月肿瘤复发并死亡,其余恢复良好。结论肝切除联合腹腔热灌注化疗应用于肝癌自发破裂出血是安全、有效的,具有止血确切、防治肿瘤种植转移及复发的优势。     

Treatment of peritoneal carcinomatosis with hyperthermic intraperitoneal chemotherapy in colorectal cancer

The peritoneum is the second most common site of metastasis after the liver and the only site of metastatic disease in approximately 25% of patients with colorectal cancer (CRC). In the past, peritoneal carcinomatosis in CRC was thought to be equivalent to distant metastasis; however, the transcoelomic spread of malignant cells is an acknowledged alternative pathway. Metastasectomy with curative intent is well accepted in patients with liver metastasis in CRC despite the paucity of randomized trials. Therefore, there is rationale for local treatment with peritonectomy to eliminate macroscopic disease, followed by hyperthermic intraperitoneal chemotherapy to destroy any residual free tumour cells within the peritoneal cavity. The aim of this paper is to summarize the current evidence for cytoreduction and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis in CRC.