单侧肺隔离高温灌注治疗肺癌

单侧肺隔离高温灌注治疗肺癌王伟综述　黄孝迈孙玉鹗　审校１９５０年，Ｋｌｏｐｐ［１］提出将化疗药物注入肿瘤某一营养动脉，从而可提高杀灭肿瘤的药物浓度、并可减少全身副作用的概念。据此Ｃｒｅｅｃｈ［２］认为心肺机可使肿瘤与全身循环暂时隔离阻断，并维持肿瘤部...     

肝脏隔离高温灌注化疗术的麻醉处理

肝癌是消化系统常见的恶性肿瘤 ,病人就诊时多不是早期 ,不足 30 %的病人能接受手术切除病变肝脏 ,临床治疗效果欠佳 ,寻求治疗肝癌新技术是国内外研究的热点。肝脏隔离灌注高浓度的抗肿瘤药加局部高温 (ｉｓｏｌａｔｅｄｈｙｐｅｒｔｈｅｒｍｉｃｌｉｖｅｒｐｅｒｆｕｓｉｏｎ ,ＩＨＬＰ)是治疗不可切除肝癌的新技术[1 ] ,ＩＨＬＰ手术期间需建立两条体外转流通路 ,对病人的生理干扰大 ,麻醉处理有其特殊性 ,现将我院开展一例ＩＨＬＰ手术的麻醉报告如下。临床资料病人男性 ,5 0岁 ,体重 6 0ｋｇ ,因右上腹胀痛伴纳差、乏力 1个月 ,以原发…     

下肢骨肉瘤高温隔离灌注化疗初步报告

自１９９０年８月－１９９２年７月，作为新辅助化疗之一部分，１４例下肢骨肉瘤进行了顺铂或碳铂高温（４２℃－４２．５℃）隔离灌注化疗，同时结合静脉滴注阿霉素。灌注后所有病人疼痛消失，肿块缩小，关节活动度增加，手术后病理检查１３例（９２．９％）反应明显，肿瘤坏死率达９０％以上，说明本法局部效果非常良好，十分有利于施行保肢手术。     

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     

下肢恶性肿瘤高温隔离灌注化疗18例报告

下肢恶性肿瘤高温隔离灌注化疗１８例报告辽宁省肿瘤医院（沈阳，１１００４２）骨软科于三江孙平邢浩吴威病理科张吉文吴沈萍热疗作为一项治疗恶性肿瘤的新技术正引起医学界的广泛兴趣。热疗分为全身热疗和局部热疗，目前临床上主要应用是局部热疗。高温隔离灌注化疗是将...     

区域隔离肝脏灌注的研究

本研究旨在探讨区域隔离肝脏灌注(RIHP)的可行性 ,并初步评价其隔离效果 ,化疗药物局部积聚效果及肝脏损害情况。一、材料与方法1.动物选择 :幼猪 2 1头 ,随机分为 3组 :经动脉组 (实验A组 ) 7头 ;经动脉和门静脉联合组 (实验B组 ) 7头 ;对照组(C组 ,经肝固有动脉灌注化疗组 ) 7头。3组动物的体重差异无显著性 (P >0 .0 5 )。2 .手术操作 :麻醉后上腹部屋顶形切口进腹 ;A组游离左肝动脉 ,近心端结扎 ,远心端插管 ;解剖出左肝静脉 ,远端阻断 ,近端插管。B组则在左肝动脉插管后 ,继续解剖游离出左门静脉 ,近端阻断 ,远端插管 ,左肝静脉处…     

肺隔离灌注对肺癌患者循环功能的影响

肺部晚期恶性肿瘤的治疗是临床难题之一。Pierpont等的首次肺隔离灌注实验研究证实肺隔离灌注是安全可靠的且局部隔离完全，为临床应用肺隔离灌注治疗肺部恶性肿瘤提供了理论基础；随着肺隔离灌注技术的完善和化疗药物研究的进步，国外在九十年代开展肺隔离灌注的临床应用研究。肺隔离灌注对循环功能的影响至今尚无定论，故本研究拟通过20例肺癌患者实施肺隔离灌注治疗中的血液动力学变化予以探讨。     

原位肝脏隔离灌注行肝脏恶性肿瘤区域性化疗的实验研究进展(综述)

本文以肝脏隔离灌注行肝脏区域化疗的实验研究为重点,讨论动物模型的建立,灌注液成分与灌注途径及其实验研究的发展方向。     

经皮选择性肝脏隔离灌注化疗肝细胞形态及凋亡研究

目的探讨经皮选择性肝脏隔离灌注化疗（PSIHP）的可行性及隔离效果。方法实验猪8头，利用介入放射学方法进行经皮选择性肝脏隔离灌注化疗结合血液灌流。化疗药物选用5-Fu。比较灌注及未灌注区域肝细胞形态和凋亡指数。结果灌注区域肝细胞损伤明显，肝细胞凋亡指数（52．83±5．12）明显高于未灌注区域肝细胞凋亡指数（3．52±0．96）（P〈0．01）。结论PSIHP是一种简单有效的肝脏隔离灌注化疗技术，隔离效果佳，对未灌注区域肝组织有良好的保护作用。     

高温隔离灌注化疗在下肢骨与软组织肉瘤保肢治疗中的价值与限度

为了减低肢体恶性肿瘤治疗中保肢手术的局部复发率，我们从１９９０年开始对５７例下肢ⅡＢ期骨与软组织肉瘤进行术前顺铂或卡铂高温（４１～４３°Ｃ）隔离灌注化疗，同时结合静脉滴注阿霉素。本组进行保肢手术４７例、截肢手术１０例。术前化疗后显示９１％患者局部疼痛完全消失；９５％肿块明显缩小；８９．５％关节活动度改善。术后病理检查肿瘤坏死率９０％～１００％为完全反应者４９例（８６％）；６０％～９０％为部分反应者５例（８．８％）；６０％以下为无反应者３例（５．２％）。术后随访２～５年的２６例保肢者中局部复发２例（７．７％）；术后３年以上随访者２６例，无病存活１６例（６１．５％）。作者认为本法局部效果非常良好，十分利于施行保肢术手，但无助于提高存活率，对截肢者不必应用。     

Quality of Life After Hyperthermic Isolated Limb Perfusion for Locally Advanced Extremity Soft Tissue Sarcoma

Background Quality of life (QoL) and posttraumatic stress symptoms (PTSS) were studied in patients with soft tissue sarcoma (STS) of the extremities treated with isolated limb perfusion and delayed resection, with or without adjuvant irradiation. Methods Forty-one patients received a questionnaire that included the RAND-36 and Impact of Event Scale. Results Thirty-nine STS survivors (16 [41%] male and 23 [59%] female; median age, 59 years; range, 15–78 years) participated in the questionnaire survey (response rate, 95%). The median age at perfusion was 49 years (range, 14–72 years). No significant differences were found in mean scores between STS survivors and the reference group with the exception of a worse physical functioning. Patients with amputations showed significantly worse physical and social functioning and more role limitations than patients whose limbs were saved. Eleven patients (28%) had a PTSS score of 0, and eight patients (20.5%) had a score ≥ 26, which suggested the need for psychological counseling. None of these eight patients had lost a limb. Patients who indicated that the choice of treatment was made by the surgeon rather than collaboratively showed significantly decreased social functioning, more role limitations, and intrusion. Greater treatment satisfaction was significantly related to better social functioning, more vitality, better general health perception, less intrusion, avoidance, and total Impact of Event Scale scores. Conclusions Even though STS survivors’ QoL was different from that of a reference group only in physical functioning, one fifth of the patients had PTSS. An amputation, the physician’s decision rather than the patient’s decision for the perfusion treatment and a low satisfaction with the performed treatment negatively influenced QoL.     

Correlation Between Melphalan Pharmacokinetics and Hepatic Toxicity Following Hyperthermic Isolated Liver Perfusion for Unresectable Metastatic Disease

Background In the present work, we report on the results of our pilot study of hyperthermic isolated hepatic perfusion (IHP) with melphalan alone for patients with unresectable metastatic liver tumors refractory to conventional treatments, with particular regard to the correlation between pharmacokinetic findings and hepatic toxicity. Patients and methods Inclusion criteria were unresectable liver metastases, hepatic parenchyma replacement ≤50%, normal liver function, and previous failure of at least one conventional treatment. IHP was performed under hyperthermic conditions with melphalan (1.5 mg/kg body weight). Completeness of vascular isolation of the liver and drug distribution volumes of the perfusion circuit were assessed by a radiolabeled albumin-based method. Drug concentrations in perfusate and plasma were measured by means of high-performance liquid chromatography (HPLC). Results Twenty patients with unresectable liver metastases underwent IHP. No intraoperative mortality occurred. Treatment-related systemic toxicity was minimal and reversible. Three patients (15%) experienced grade 4 hepatic toxicity and died due to liver failure and subsequent multiorgan failure. Other six patients had significant (grade 3–4) but transitory hepatic toxicity. Complete and partial responses were observed in three and nine out of 17 evaluable patients, respectively (overall response rate = 70%). The pharmacokinetics study showed a 3% mean perfusate-to-plasma drug leakage (range 1–6%). Logistic regression analysis showed that drug concentration in the perfusate circuit, but not preoperative tests, significantly and independently correlated with hepatic toxicity (P = 0.028). Conclusions Following melphalan-based IHP, objective tumor regression could be observed in a remarkable percentage of patients refractory to standard treatments. However, hepatic toxicity and related mortality were significant. Our findings suggest that drug dosage personalization based on the measurement of drug distribution volumes might minimize hepatic toxicity. Presented at the 59th Annual Cancer Symposium of the Society of Surgical Oncology, San Diego, California, USA, 23–26 March 2006     

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。     

Isolated Lung Perfusion for the Treatment of Pulmonary Metastatic Disease: a Review

Isolated lung perfusion with chemotherapeutic agents is an experimental technique for the treatment of lung metastatic disease from certain solid tumours. The technique had already been developed in the late 1950s but underwent a revival in the early 1980s. By that time, experimental work in large and small animals induced extensive clinical work with different agents such as doxorubicin, tumour necrosis factor, melphalan and cisplatin for which safety profiles and maximal tolerated doses were defined. A review of current work is presented in this article.     

Current Techniques of Hyperthermic Isolated Limb Perfusion for Malignant Melanoma

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

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.