30例腹膜腔转移瘤腹腔温热灌注化疗的临床观察

目的:观察腹膜腔转移瘤腹腔温热灌注化疗的临床疗效及不良反应.方法:常规检查血常规、肝肾功能、心电图、电解质及腹部B超或CT等,常规腹腔穿刺,如有腹水,则放2/3以上的腹水,先灌注500ml、42℃-43℃的生理盐水,再将化疗药物及生物制剂分别用牛理盐水稀释至20ml-40ml注入腹腔;如无腹水,先经穿刺针输注生理盐水42℃-43℃ 500ml,确定灌注通畅后,先将化疗药物分别稀释于提前预热的500ml(42℃-43℃)生理盐水中,依次通过穿刺针输入,生物制剂及呋塞米、多巴胺、地塞米松用常温生理盐水稀释(20ml-40ml)输入.总输入液体量约2000ml-2500ml,化疗药物以DDP、5-FU、EPI为主.无腹水而单纯灌注者,每4周1次,连用3次为1疗程;伴腹水者,每周1次,连续3次为1疗程.均完成1疗程后,评价疗效及不良反应.结果:总有效率为83.4%,Ⅱ°-Ⅲ°骨髓抑制26例(占86.7%),Ⅱ°-Ⅲ°胃肠道反应(恶心、呕吐、食欲下降、腹泻)者28例(占93.3%),轻度发热37.5℃-38.0℃13例(占43.3%),无1例发生电解质紊乱、酸碱平衡失调及肝肾功能受损.结论:腹腔温热灌注化疗具有毒副作用小、经济、安全、有效,患者依从性较好、操作简单等优点,是一种值得在基层医院推广的治疗方法.     

腹腔热灌注化疗联合细胞减灭术对胆囊癌腹膜转移的临床疗效研究

目的:探讨腹腔热灌注化疗(hyperthermic intraperitoneal chemtheropy,HIPEC)治疗胆囊癌伴腹膜转移患者的临床疗效研究。方法:本文回顾性分析海军军医大学东方肝胆外科医院2015年1月至2018年1月收治的84例胆囊癌合并腹膜转移患者,31例患者给予HIPEC联合细胞减灭术(cytoreductive surgery,CRS)+术后1个月全身化疗为研究组,53例给予细胞减灭术+术后1个月全身化疗为对照组,观察比较两组临床疗效及不良反应发生情况。结果:研究组中位生存时间为(21.72±2.96)个月,显著长于对照组的(14.93±2.09)个月(P<0.05)。研究组白细胞减少、血红蛋白减少、血小板减少、胃肠道反应、肝功能损伤和肾功能损伤较对照组无显著性差异(P>0.05)。结论:HIPEC治疗进展期胆囊癌临床疗效显著,可延长患者生存时间,不良反应较小,值得推广应用。     

腹腔内温热灌注化疗的临床应用

晚期腹腔恶性肿瘤的治疗临床上较为棘手,我们应用温热对癌细胞的生物学效应设计了简易的腹腔内温热灌注化疗方法（ｉｎｔｒａｐｒｉｔｏｎｅａｌｃｈｅｍｈｙｐｅｒｔｈｅｍｉｃｒｅｒｆｏｕｓｉｏｎ,ＩＣＨＰ）治疗晚期腹腔恶性肿瘤,获得了较为满意的效果,现报告如下。１　材料与方法１．１　临床资料　全组３１例患者均系我科确诊已无手术指征或术后复发、腹膜转移的中晚期患者。随机行简易腹腔内温热灌注化疗（灌注组）和全身化疗（对照组）,并作对照研究。灌注组１６例,男１０例,女６例,年　　作者单位：云南省昆明市延安医院　…     

腹腔温热灌注化疗治疗恶性腹水疗效

目的 观察卡铂、丝裂霉素、5-Fu联合腹腔灌注温热化疗，治疗恶性腹腔积液的疗效。方法 于左髂前上棘与脐连线中外1／3交点处(多选反麦氏点)穿刺，静脉留置针在腹腔后输入500ml生理盐水后，再输入500ml生理盐水加化疗药物，为减轻局部反应，最后输入500ml生理盐水加速尿40mg及地塞米松10mg。所有液体均应用电浴锅保证所用液体温度保持在43℃～45℃。穿刺后嘱患者变换体位，每10分钟变换一次，共12次。化疗方案：卡铂400mg／m^2d1；5-Fu750mg／m^2d2、4；MMC10mg／m^2 d3、5。28天一次。结果 卡铂、丝裂霉素、5-Fu腹腔联合灌注化疗治疗恶性腹腔积液单周期腹腔灌注化疗后有效率80．70％(46／57)；两周期灌注化疗有效率86．54％(45／52)；三周期灌注化疗有效率91．67％(44／48)。结论 腹腔使用卡铂、丝裂霉素、5-Fu三药联合化疗有效率高，毒副反应无明显增加，是一种值得推广的治疗方法。     

腹腔温热化疗及全身化疗治疗消化道肿瘤45例疗效观察

目的：探讨腹腔温热化疗及静脉化疗治疗消化道肿瘤的临床应用价值。方法：治疗组45例病人中32例为根治术后，采用腹腔内注人顺铂80－100mg，每7－10天重复，连用3－4次，之后给予FAM方案（氟脲嘧啶、阿霉素、丝裂霉素）静脉化疗，13例晚期失去手术机会的病人给予FAM方案静脉化疗配合腹腔化疗。并与对照组31例治术后单用FAM方案静脉化疗的病人相比较。结果：治疗组和对照组3年生存率分别为70％、40．3％（P＜0．01），腹腔复发率分别为6．25％、48．4％，肝转移率分别为3．13％、32．3％。疗效明显优于对照组（P＜0．01）。13例晚期期病人的近期疗效PR69．2％，明显优于单用公认的静脉联合化疗的疗效。结论：腹腔温热化疗＋静脉化疗不胆能有效降低胃肠道肿瘤术后腹腔复发及转移，提高3年生存率，而且能提高晚期病人的近期有效率及生存质量。     

减瘤术联合术中腹腔内温热化疗治疗消化道肿瘤腹膜转移

消化道恶性肿瘤腹膜转移在临床十分常见,预后极差。近年来,减瘤术联合术中腹腔内温热化疗方案治疗效果满意。现综述如下。     

腹腔温热化疗研究现状和进展

腹腔温热化疗(IHCP)作为消化道肿瘤根治术后的一种辅助疗法,效果肯定.本文着重介绍IHCP近几年的研究进展.     

腹腔DDP温热灌注化疗联合IL-2治疗恶性腹膜间皮瘤1例

目的:评价腹腔DDP温热灌注化疗联合IL-2对恶性腹膜间皮瘤的治疗效果.方法:DDP稀释后加温快速腹腔内灌注,之后IL-2及地塞米松腹膜腔内灌注,监测每次腹水引出量进行对比.结果:疗效确切,腹腔积液完全消失.结论:目前恶性腹膜间皮瘤的诊断尚无特异方法,腹腔DDP温热灌注化疗联合IL-2治疗恶性腹膜间皮瘤不失为理想选择之一.     

腹腔温热化疗及全身化疗治疗消化道肿瘤45例疗效观察

目的　探讨腹腔温热化疗及静脉化疗治疗消化道肿瘤的临床应用价值。方法　治疗组 45例病人中 32例为根治术后 ,采用腹腔内注入顺铂 80～ 10 0 mg,每 7～ 10天重复 ,连用 3～ 4次 ,之后给予 FAM方案 (氟脲嘧啶、阿霉素、丝裂霉素 )静脉化疗。 13例晚期失去手术机会的病人给予 FAM方案静脉化疗配合腹腔化疗。并与对照组 31例根治术后单用 FAM方案静脉化疗的病人相比较。结果　治疗组和对照组 3年生存率分别为 70 %、40 .3% (P<0 .0 1) ,腹腔复发率分别为 6 .2 5 %、48.4%。肝转移率分别为 3.13%、32 .3%。疗效明显优于对照组 (P<0 .0 1)。 13例晚期病人的近期疗效PR6 9.2 % ,明显优于单用公认的静脉联合化疗的疗效。结论　腹腔温热化疗 静脉化疗不但能有效降低胃肠道肿瘤术后腹腔复发及转移 ,提高 3年生存率 ,而且能提高晚期病人的近期有效率及生存质量     

复发卵巢癌腹腔温热化疗联合全身化疗临床研究

目的探讨复发卵巢癌卡铂腹腔温热化疗联合多西他赛全身化疗的疗效和毒副作用。方法将70例Ⅲ～Ⅳ期复发卵巢癌患者按随机原则选择35例作为治疗组,采用卡铂腹腔温热化疗联合多西他赛全身化疗;35例作为对照组,采用卡铂联合多西他赛全身化疗,并对两组化疗后1,3,5年生存率及毒副作用对照研究,并经统计学χ2检验。结果治疗组1,3,5年生存率分别为88.6%（31/35）、65.7%（23/35）和37.1%（13/35）,对照组分别为80.0%（28/35）、51.4%（18/35）和22.9%（8/35）,两组比较差异无显著性（P〈0.05）。毒副作用主要是骨髓抑制,白细胞下降率（Ⅲ～Ⅳ度）分别为5.7%（2/35）和31.4%（11/35,P〈0.05）。结论复发卵巢癌卡铂腹腔温热化疗联合多西他赛全身化疗的疗效优于卡铂联合多西他赛全身化疗,且毒副作用轻,有利于提高患者的生存率及生存质量。     

大肠癌术后腹腔低渗温热化疗

目的研究腹腔低渗温热化疗对大肠癌术后腹腔内及肝转移的预防效果.方法收集自1996年7月～1999年12月大肠癌手术病例,随机分为两组A组腹腔低渗温热化疗组.B组常规静脉化疗组.观察腹腔复发率、肝转移率、生存率.结果A组腹腔复发率7.5%(4/53),肝转移率5.7%(3/53),1年、2年生存率分别为96.8%(60/62)、88.7%(55/62).B组腹腔复发率11.8%(6/51),肝转移率15.7%(8/51),1年、2年生存率分别为82.8(48/58)、74.1%(43/58).结论腹腔低渗温热化疗对预防大肠癌术后腹腔内复发、肝转移、提高生存率有显著疗效.     

Treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: state of the art and future developments

Peritoneal carcinomatosis (PC) had long been regarded as a terminal disease, characterized by a very poor survival and worth treating with palliative therapy. A new strategy combining maximal surgery (cytoreductive surgery, CRS), with maximal regional chemotherapy (hyperthermic intraperitoneal chemotherapy, HIPEC), has been proposed to treat PC, resulting in long-term survival rates in selected patients. The emerging trend is to view localised peritoneal carcinomatosis, in the absence of other metastases, as a regional metastatic disease that is amenable to locoregional therapy. In spite of the need for more high quality studies, many international experts now agree that the use of this new strategy is a gold standard for treating selected patients with PC with the intent of curing. The best results are achieved in patients with limited disease who have completed macroscopic tumor removal. To offer a comprehensive review, we summarized the present status and possible future progress of this treatment modality, in particular outlining its rationale, current practice and general outcome.     

Outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal mesothelioma and predictors of survival

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) benefits selected patients with peritoneal mesothelioma. We present the outcomes of this treatment strategy in a UK peritoneal malignancy national referral centre.

Methods: Observational retrospective analysis of data prospectively collected in a dedicated peritoneal malignancy database between March 1998 and January 2016.

Results: Of 1586 patients treated for peritoneal malignancy, 76 (4.8%) underwent surgery for peritoneal mesothelioma. Median age was 49?years (range 21–73?years). 34 patients (45%) were female. Of the 76 patients, 39 (51%) had low grade histological subtypes (mostly multicystic mesothelioma), and 37 (49%) had diffuse malignant peritoneal mesothelioma (DMPM; mostly epithelioid mesothelioma). Complete cytoreduction was achieved in 52 patients (68%) and maximal tumour debulking (MTD) was performed in 20 patients (26%); the remaining 4 patients (5%) underwent a laparotomy with biopsy only. HIPEC was administered in 67 patients (88%). Median overall (OS) and disease-free survival (DFS) after CRS was 97.8 (80.2–115.4) and 58.8 (47.4–70.3) months, respectively. After complete cytoreduction, 100% overall survival was observed amongst patients with low-grade disease. Ki-67 proliferation index was significantly associated with survival outcomes after complete cytoreduction for DMPM and was an independent predictor of decreased survival.

Conclusion: With adequate patient selection (guided by histological classification and Ki-67 proliferation index) and complete cytoreduction with HIPEC, satisfactory outcomes can be achieved in selected patients with peritoneal mesothelioma.     

Chemotherapy for intraperitoneal use: a review of hyperthermic intraperitoneal chemotherapy and early post-operative intraperitoneal chemotherapy

Peritoneal spread of tumors is a major problem in cancer management. Patients develop a marked deterioration in quality of life and shortened survival. This is in part due to bowel obstructions, marked ascites, and overall increase debilitation. Standard medical management has shown to be inadequate for the treatment of these problems. Surgery can palliate symptoms, however, it is unable to be complete at the microscopic level by a significant spillage of tumor cells throughout the abdomen. Chemotherapy can have some improvement in symptoms however it is short lived due to poor penetration into the peritoneal cavity. The role of intraperitoneal chemotherapy is to maximize tumor penetration and optimize cell death while minimizing systemic toxicity. Hyperthermic intraperitoneal chemotherapy (HIPEC) and early post-operative intraperitoneal chemotherapy (EPIC) are two treatment methods that serve this role and have been shown to improve survival. This review will discuss different chemotherapies used for both of these treatment options.     

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal sarcomatosis—A systematic review and meta-analysis

Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) play an important role in the treatment of various peritoneal surface malignancies, but its efficacy in peritoneal sarcomatosis (PS) remains unknown. Hence, we performed a systematic review and meta-analysis to investigate outcomes of CRS-HIPEC in PS, in accordance with PRISMA guidelines. 16 studies with a total of 320 patients were included in the meta-analysis. Pooled mean length of hospital stay after CRS-HIPEC was 16.0 days (95% CI: 12.2–19.8) and rate of serious complications was 17.4% (95% CI: 9.8–26.3). The median DFS was 12.0 months (95% CI: 8.0–16.0) and the 5-year DFS was 21.8% (95% CI: 13.2–31.7). Overall pooled median OS was 29.3 months (95% CI: 23.8–34.8), with a 5-year OS of 35.3% (95% CI: 26.3–44.8). Subgroup analysis showed that patients with CC-0 cytoreduction had a higher median OS of 34.6 months (95% CI: 23.2–45.9). Median OS for patients with a primary tumour histology of leiomyosarcoma and liposarcoma was 33.5 months (95% CI: 15.9–51.1) and 39.1 months (95% CI: 20.8–57.5) respectively. The site of recurrence was locoregional in 57.3% (95% CI: 38.9–74.8), distant in 17.3% (95% CI: 3.9–35.6), and both in 17.4% (95% CI: 5.8–32.2). In conclusion, our results suggest that CRS-HIPEC may improve outcomes in a select group of PS patients.     

Cytoreductive surgery and intraperitoneal chemotherapy versus systemic chemotherapy for colorectal peritoneal metastases: A randomised trial

BackgroundFirst-line treatment of isolated resectable colorectal peritoneal metastases remains unclear. This study (the Swedish peritoneal study) compares cytoreductive surgery and intraperitoneal chemotherapy (surgery arm) with systemic chemotherapy (chemotherapy arm).MethodsPatients deemed resectable preoperatively were randomised to surgery and intraperitoneal 5-fluorouracil 550 mg/m²/d for 6 d with repeated courses every month or to systemic oxaliplatin and 5-fluorouracil regimen every second week. Both treatments continued for 6 months. Primary end-point was overall survival (OS) and secondary end-points were progression-free survival (PFS), and morbidity.ResultsThe study terminated prematurely when 48 eligible patients (24/arm) were included due to recruitment difficulties. Two-year OS was 54% in the surgery arm and 38% in the chemotherapy arm (p = 0.04). After 5 years, 8 versus 1 patient were alive, respectively (p = 0.02). Median OS was 25 months versus 18 months, respectively, hazard ratio 0.51 (95% confidence interval: 0.27–0.96, p = 0.04). PFS in the surgery arm was 12 months versus 11 months in the chemotherapy arm (p = 0.16) with 17% versus 0% 5-year PFS. Grade III–IV morbidity was seen in 42% and 50% of the patients, respectively. No mortalities.ConclusionsCytoreductive surgery with intraperitoneal chemotherapy may be superior to systemic oxaliplatin-based treatment of colorectal cancer with resectable isolated peritoneal metastases.(ClinicalTrials.gov nr:NCT01524094).     

腹腔热灌注化疗治疗晚期胃肠癌并腹膜转移的疗效观察及护理体会

目的：探讨腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）治疗晚期胃肠癌并腹膜转移的疗效及其护理体会。方法选取2015年1月至2015年12月在本院治疗的25例晚期胃肠癌伴有腹膜转移患者,行腹腔热灌注化疗,观察其并发症和临床疗效,总结护理经验。结果25例患者均顺利完成腹腔热灌注化疗。 HIPEC术后短期疗效中完全缓解（complete remission, CR）80％（20／25）,部分缓解（partial remission,PR）20％（5／25）,总有效率为100％;术后患者无吻合瘘发生;Ⅰ～Ⅱ骨髓抑制发生率为20％（5／20）;轻－中度胃肠道反应为36％（9／25）;术后患者胃肠功能恢复延迟为24％（6／25）;低蛋白血症占80％（20／25）;切口感染和延迟愈合占4％（1／25）;28％出现管周渗液（7／25）;护理满意度为92％（23／25）;随访4～15个月,中位生存期8．3个月。结论腹腔热灌注化疗能有效控制晚期胃肠癌恶性腹水的发展。严格的规范化护理能提高治疗的安全性,减少并发症的发生,提高患者满意度。