腔内灌注热化疗仪的研制

目的　为满足临床进行腔内灌注热化疗的需要 ,研制 1台能精确控制温度和流速的热化疗仪。方法　采用精密蠕动泵、单片机控制 (MCU)系统、比例积分微分 (PID)算法和自制的小于 0 .5mm直径的温度传感器。结果　完成 1台热化疗仪样机 ,在温度为 30℃～ 6 0℃范围内 ,控制精度小于± 0 .3℃ ;流量控制范围 0～ 70 0ml/min ,精度小于1.7ml/min。结论　经体模实验证实 ,该热化疗仪操作简单、工作稳定、控制精确 ,可用于腔内灌注热化疗实验     

基于单片机的全自动腹腔灌注热化疗仪的系统设计

针对腹腔肿瘤提出的一种热疗与化疗复合治疗的新方法。本文设计了这套智能型全自动腹腔灌注热化疗设备。利用加热炉丝加热化疗药物,通过恒流泵将药液送入人体腹腔,从腹腔流出的药液废弃掉。系统采用单片机对加热温度及流速进行控制,以使腹腔内化疗药液温度恒定在最佳温度值附近。     

卵巢癌细胞减瘤术后腹腔热灌注化疗临床疗效及安全性的荟萃分析

目的 评估卵巢癌细胞减瘤术后腹腔热灌注化疗的临床疗效和安全性.方法 按制定的标准选取公开发表的文献,分别记录手术的种类和方法、腹腔热灌注化疗的方式、并发症、病死率、住院时间和生存时间等,并对化疗药物剂量、热灌注的方法、化疗持续时间等进行描述.结果 本荟萃分析最终有14篇符合标准的文献入选,7项研究表明进行了肿瘤根治术后腹腔热灌注化疗的患者预后较好.原发性卵巢癌和复发性卵巢癌患者治疗后的中位生存期为22个月到54个月;中位无病生存期为10个月到26个月.卵巢癌细胞减瘤术后腹腔热灌注化疗的严重并发症发生率为5％ ～ 36％;中位病死率3％(0％～10％),并发症发生率和病死率均较低.结论 卵巢癌患者细胞减瘤术后腹腔热灌注化疗是可以选择的一种良好的治疗方式,临床应用安全可行.     

腹腔灌注及静脉化疗配合热疗治疗晚期卵巢癌的临床观察

目的评价腹腔及静脉化疗配合局部热疗治疗晚期卵巢癌的疗效。方法2003年1月～2005年1月收治的48例卵巢癌病人随机分为观察组25例,对照组23例。观察组采用腹腔灌注和静脉化疗,同时局部给予热疗,对照组仅给予腹腔及静脉化疗。结果观察组和对照组有效率分别为56．0％和21．7％。结论腹腔及静脉化疗配合热疗治疗卵巢癌的疗效优于单纯腹腔及静脉化疗,对治疗晚期卵巢癌有一定的临床价值,值得推广应用。     

高精度腹腔热灌注治疗系统设备的开发研究

目的 介绍一种高精度腹腔热灌注治疗系统的总体设计原理及系统的总体构成方法.方法 高精度"BR-TRG-Ⅱ型腹腔热灌注治疗系统"由控制系统、外循环系统、热交换器、内循环系统4部分构成.从功能卜分为5个功能子系统:计算机主控子系统包括以AVR单片机为核心的主控制电路,数据采集和处理子系统,加热制冷子系统,循环子系统和报警子系统.结果 本系统具有专用计算机热疗软件,全程动态控制,可实现治疗参数设置、自适应温度控制、治疗数据显示、自动存储、报警等功能.动物实验及临床初步应用结果表明,该设备测温精度达±0.1℃,控温精度±0.16℃,腹腔液体灌注速度精确到5%,各项性能完全达到临床设计要求.结论 高精度"BR-TRG-Ⅱ型腹腔热灌注治疗系统"加温、恒温和降温完全达到临床设计要求,性能稳定、安全可靠、操作便利,便于临床推广应用.     

晚期胃癌的腹腔热灌注联合全身静脉化疗临床疗效的观察

目的探讨合并腹腔和肝脑脏器转移的晚期胃癌患者,腹腔热灌注化疗联合全身静脉化疗的临床疗效。方法 23例晚期胃癌患者分为2组,实验组10例行腹腔热灌注化疗联合全身静脉化疗,对照组13例仅行单纯静脉化疗。比较2组患者的不良反应和并发症、生存情况、KPS评分情况。结果实验组总生存期较对照组延长,差异有统计学意义(P=0.003)。2组治疗前的生存质量KPS评分没有统计学差异(P=0.835),2组患者的不良反应及并发症发生率无统计学差异。结论合并腹腔和肝脑脏器转移的晚期胃癌患者,行腹腔热灌注化疗联合全身静脉化疗较单纯全身静脉化疗,可能有助于改善其生存质量和延长生存期。     

手术加腹腔内温热灌注治胃肠道癌

手术加腹腔内温热灌注治胃肠道癌广西一项研究证实，手术加腹腔内温热灌注化疗联合治疗是控制中晚期胃肠道癌术后局部复发的一种有效方法。广西医大第一附属医院陈利生、高枫等５位临床医师在行肿瘤切除或姑息性手术后，通过加温灌流驱动装置，将加温４３℃～４７℃的化疗...     

腹腔热灌注化疗联合全身化疗治疗中晚期胃肠道肿瘤的临床观察

目的观察分析临床对中晚期胃肠道肿瘤患者实施腹腔热灌注化疗、全身化疗联合治疗后的临床效果。方法择取我院既往接诊的65例中晚期胃肠道肿瘤患者,并将其中单纯实施全身化疗的32例记为A组,将其中实施腹腔热灌注化疗、全身化疗联合治疗的33例患者记为B组,比较两组患者治疗后的临床效果。结果B组患者经过治疗后其临床治疗有效率为57.58%,明显高于A组患者的28.13%(<0.05);在生存率方面,B组患者无论是在3年内的生存率还是5年内的生存率均明显高于A组患者(<0.05)。结论临床对中晚期胃肠道肿瘤患者实施腹腔热灌注化疗、全身化疗联合治疗后的临床疗效理想,相比单纯的全身化疗其安全性也无明显改变,值得各医院广泛应用。     

胃癌术后早期腹腔循环热灌注化疗的临床应用分析

目的：观察分析胃癌术后早期腹腔循环热灌注化疗的临床应用效果。方法回顾性分析78例胃癌手术患者临床资料,按术后化疗方法分为研究组(39例)和对照组(39例),两组患者均给予静脉化疗,研究组在此基础上加以早期腹腔循环热灌注化疗,对比观察两组临床应用效果。结果研究组术后不良反应、并发症与对照组对比,无统计学差异意义(P>0.05);研究组复发率、生存率、细胞免疫功能变化对比,具有统计学差异意义(P<0.05)。结论在静脉化疗基础上,给予胃癌术后患者早期腹腔循环热灌注化疗,可取得显著的临床应用效果,能有效降低患者复发率,提高生存率,改善细胞免疫功能,是胃癌术后理想的化疗方法。     

膀胱热灌注化疗对兔膀胱粘膜的病理生理影响

目的探讨不同温度下丝裂霉素（MMC）膀胱腔内热灌注化疗的安全性。方法雌性新西兰大白兔18只,随机分为6个小组,每组3只。实验组为第1～5小组,将MMC80mg加入生理盐水600ml中,用恒温水浴箱加热药液,温度为第1小组46℃,第2小组48℃,第3小组50℃,第4小组52℃,第5小组54℃,灌注实验兔膀胱45min;对照组为第6小组,不加热药液,同条件下灌注实验兔膀胱。比较实验前后实验兔的生化指标变化。2周后处死实验兔,观察不同温度条件下膀胱粘膜的病理改变。结果病理检查结果显示,入水温度在45℃以下的实验兔膀胱与对照组无明显变化,随着治疗温度的升高,实验兔膀胱的热损伤加大。实验组治疗后生化指标较治疗前有变化,谷丙转氨酶、肌酐、尿酸、岩藻糖苷酶、谷氨酰转肽酶治疗前后的变化率与入水温度的变化呈正相关,总蛋白、白蛋白治疗前后的变化率与入水温度的变化呈负相关（P〈0.05）。结论在45℃以下,丝裂霉素膀胱腔内热灌注化疗45min是安全的,随着治疗温度的升高,膀胱粘膜的热损伤加重,治疗的副作用加大,风险增高。     

恩度联合洛铂胸腔热灌注化学治疗恶性胸腔积液的近期临床观察

目的观察恩度联合洛铂胸腔热灌注化学治疗(简称化疗)恶性胸腔积液的近期疗效和不良反应。方法选择2010年1月~2012年8月60例恶性胸腔积液患者,其中男性34例,女性26例;年龄35~65岁,中位年龄50.5岁。按照随机数字法分成观察组和对照组,各30例。所有患者均行胸腔穿刺置管,充分引流胸水,观察组采用恩度30 mg+洛铂30 mg/m2行胸腔热灌注化疗,对照组单纯洛铂30 mg/m2行胸腔热灌注化疗,热疗循环温度控制在41.5℃,每次治疗时间60 min,治疗周期为7~10 d,连续治疗4次。结果观察组患者,16例获得完全缓解,9例部分缓解,总有效率为83.3%;对照组中,12例获得完全缓解,9例部分缓解,总有效率为70.0%;两组间差异有统计学意义(P0.05)。两组患者生活质量(QOL)亦有明显改善(P0.05)。两组患者Ⅲ+Ⅳ度骨髓抑制发生率差异无统计学意义(P0.05)。结论恩度联合洛铂胸腔热灌注化疗恶性胸腔积液疗效显著,QOL改善明显,不良反应轻,值得推广应用。     

The Groningen Hypothermic Liver Perfusion Pump: Functional Evaluation of a New Machine Perfusion System

To improve preservation of donor livers, we have developed a portable hypothermic machine perfusion (HMP) system as an alternative for static cold storage. A prototype of the system was built and evaluated on functionality. Evaluation criteria included 24 h of adequate pressure controlled perfusion, sufficient oxygenation, a maintained 0–4°C temperature and sterile conditions. Porcine livers were perfused with pump pressures that were set at 4 mmHg (continuous, portal vein) and 30/20 mmHg, at 60 BPM (pulsatile, hepatic artery). Control livers were preserved using the clinical golden standard: static cold storage. In the HMP group, pressure, flow and temperature were continuously monitored for 24 h. At time-points t = 0, 2, 4, 8, 12, and 24 h samples of University of Wisconsin machine preservation solution were taken for measurement of partial oxygen pressure (pO₂) and lacto-dehydrogenase. Biopsies in every lobe were taken for histology and electron microscopy; samples of ice, preservation solution, liver surface, and bile were taken and cultured to determine sterility. Results showed that temperature was maintained at 0–4°C; perfusion pressure was maintained at 4 mmHg and 30/20 mmHg for portal vein and hepatic artery, respectively. Flow was approximately 350 and 80 ml/min, respectively, but decreased in the portal vein, probably due to edema formation. Arterial pO₂ was kept at 100 kPa. Histology showed complete perfusion of the liver with no major damage to hepatocytes, bile ducts, and non-parenchymal cells compared to control livers.The machine perfusion system complied to the design criteria and will have to demonstrate the superiority of machine perfusion over cold storage in transplant experiments.     

Hypothermic Machine Preservation in Liver Transplantation Revisited: Concepts and Criteria in the New Millennium

To overcome the present shortage of liver donors by expansion of the existing donor pool and possibly lengthening of the storage time, hypothermic machine perfusion of the liver as a dynamic preservation method is revisited. The three most important aspects are defined to be the type of preservation solution, the characteristics of perfusion dynamics, and the oxygen supply. Reviewing hypothermic liver machine perfusion experiments, the University of Wisconsin machine preservation solution is the solution most used. It is also found that nothing conclusive can be said about the optimal perfusion characteristics, since either perfusion pressure or perfusion flow is reported. The best estimation is perfusion of the liver in a physiological manner, i.e. pulsatile arterial perfusion and continuous portal venous perfusion. The applied pressures could be chosen to be somewhat lower than physiological pressures to prevent possible endothelial cell damage. Oxygen supply is necessary to achieve optimal preservation of the liver. The minimal amount of partial oxygen pressure required is inversely related to the normalized flow. Incorporating these features in a system based on existing standard surgical and organ sharing procedures and which is able to work stand-alone for 24 h, weighing less than 23 kg, could successfully implement this technique into every day clinical practise.     

细胞减瘤术联合腹腔热灌注化疗治疗在结直肠癌腹膜转移的临床应用

结直肠癌腹膜转移是结直肠癌的终末期病变,预后较差,多采用保守治疗。近年来,细胞减瘤术联合腹腔热灌注化疗治疗结直肠癌腹膜转移逐渐被接受,可显著改善患者的预后,但由于其设备的缺乏、手术的复杂、并发症相对较多等原因未得到普遍应用。本文对其理论基础、技术方法、临床研究及风险与安全等方面进行了综述,探索结直肠癌腹膜转移的多模式治疗方案,进一步提高结直肠癌腹膜转移患者的治疗效果。     

胸腔热灌注治疗中应用右美托咪定复合地佐辛的临床观察

目的观察胸腔热灌注治疗中应用右美托咪定复合地佐辛的临床效果。方法以2013年1月至10月本院收治的全麻下行胸腔热灌注治疗的患者40例为研究对象,按随机数字表分为右美托咪定＋芬太尼组（A组）和右美托咪定＋地佐辛组（B组）,分别于术前10min给予芬太尼1．0μg/kg、地佐辛0．1mg／kg,术中均静脉持续泵注右美托咪定。记录两组患者治疗开始后5min（T1）、15min（T2）、30min（T3）、60min（T4）4个时点的视觉模拟评分（VAS）及T3、T4时点的Ramsay镇静评分,记录术中不良反应的发生情况。结果术中各时点两组患者的VAS评分差异无统计学意义（均P〉0．05）。T3、T4时点,B组患者的镇静评分明显高于A组（2．45±0．61比1．50±0．55,2．78±0．75比2．45±0．92,均P〈0．05）。与A组比较,B组患者不良反应发生较少。结论右美托咪定复合地佐辛用于胸腔热灌注治疗术中镇静镇痛,效果确切,不良反应较少。     

Thermal method for continuous measurement of cerebral perfusion

A new thermal system using constant heating power for continuous measurement of cerebral perfusion is presented. It is designed and implemented for optimal perfusion sensitivity and dynamic response based on heat-transfer analysis of perfused brain tissue with thermistors on the cortical surface. Two matched thermistors are used, one to serve as a perfusion sensor and the other to compensate for the base-line temperature changes. To improve the signal-to-noise ratio of the measurement system, lock-in amplifiers are used to minimise long-term drift and low-frequency noise. Errors in the measurement caused by electrical and thermal fluctuations are tested and analysed. In vitro tests show that the measurement accuracy of temperature change is better than 10⁻³°C, and the temperature resolution is even greater. In vivo evaluation confirms that the system is responsive to cerebral perfusion changes associated with sudden changes in mean arterial blood pressure caused by bolus injection of norepinephrine, blood withdrawal and blood infusion. The dynamic response of the system is sufficient to detect the autoregulatory perfusion changes in response to arterial blood pressure alteration and the oscillations of cerebral blood flow.     

家兔体外血浆灌流实验方法的建立

目的建立兔体外血浆灌流的动物实验方法,用于评价一种体外血浆脂类吸附过滤器。方法以高脂血症大耳白兔为模型动物,先后使用了2种不同面积的中空纤维型血浆分离器,通过5mL真空采血管离心和100mL生理盐水袋离心等方法,将血浆与血细胞分离,通过蠕动泵在体外建立血浆循环。结果0．3m2的血浆分离器能够将血浆与血细胞有效分离,顺利进行血浆循环;但是,由于该型号的血浆分离器的容积过大,动物失血过多,因肺水肿等原因导致动物死亡。0．1m2的小型血浆分离器不能将高脂血症动物血浆与血细胞分离;而使用采血管,采血速度不能控制,操作时间长,血细胞损失过多,动物死亡率高。利用100mL生理盐水袋作为离心分离容器,分批采血,采用15％的枸橼酸钠溶液抗凝,离心分离血浆与血细胞,血浆进行体外循环;同时严格控制采血速度、回输速度以及抗凝条件,成功地建立了兔体外血浆灌流实验方法和方案,操作简单,动物存活率高。结论利用100mL生理盐水袋分批采血,离：0法分离血浆与血细胞,建立血浆体外循环。操作简单,比膜血浆分离器费用低,动物存活率高,是进行血液净化相关材料评价的理想的兔体外血浆灌流模型。     

Steady-state analysis and evaluation of a new thermal sensor for surface measurements of tissue perfusion

The steady-state response and operating characteristics of a new thermal sensor for surface measurements of local tissue perfusion have been analyzed theoretically and evaluated in vivo. The flow measurement system incorporates an electrically isolated thin-film thermal sensor, which is maintained at a fixed temperature by high frequency response electronic circuitry. The sensor rests on the tissue surface, and the power required to maintain a fixed probe to tissue temperature elevation is measured and related to tissue blood flow. A theoretical analysis of the steady-state probe response to flow changes was carried out employing the bio-heat-transfer equation and a solution based on Fourier series to describe the temperature distribution within the tissue domain. A comparison of steady-state theory to results obtained from initial experimental tests on the surface of the dog heart, over a perfusion range 0.51 to 2.00 ml/min/g, shows close agreement. The probe demonstrates good sensitivity to flow changes, provides stable and continuous measurements, and appears promising for both research and clinical applications.