Fluid dynamics in man of an intraperitoneal drug delivery solution: 4% icodextrin

Interest in targeting drugs into the peritoneal cavity for intra-abdominal cancers or infections is undergoing a revival as recent clinical trials have demonstrated, not only a regional advantage in concentration of the active agent, but also improved long-term outcomes. Solutions currently used for intraperitoneal (IP) drug delivery have short residence times, however, which can limit the exposure of all areas of the peritoneum to the active agent. Icodextrin 4% solution was compared with saline and a glucose-based peritoneal dialysis solution in a clinical study of IP residence time. The study was carried out during the fortnightly rest phase in 9 patients undergoing 5-fluorouracil (5-Fu) IP treatment for colorectal cancer. The volume remaining in the peritoneal cavity was measured at 0, 12, 24, 48, 72, and 96 hr after an instillation of 2 liters of each fluid. Saline (n = 3 dwells) and glucose (n = 3 dwells) peritoneal dialysis solutions were almost fully absorbed by 24 hr, and the patients experienced discomfort when using these solutions. In contrast, icodextrin 4% solution (n = 188 dwells) maintained its instilled volume for up to 48 hr, and half the instilled volume remained after 72 and 96 hr. This result would allow extensive and prolonged coverage of the peritoneal surface. Icodextrin 4% solution may be an effective vehicle to deliver therapeutic agents into the peritoneal cavity.     

Surgical Debulking and Intraperitoneal Chemotherapy for Established Peritoneal Metastases From Colon and Appendix Cancer

Background: Aggressive treatment of peritoneal metastases from colon cancer by surgical cytoreduction and infusional intraperitoneal (IP) chemotherapy may benefit selected patients. We reviewed our institutional experience to assess patient selection, complications, and outcome.Methods: Patients having surgical debulking and IP 5-fluoro-2-deoxyuridine (FUDR) plus leucovorin (LV) for peritoneal metastases from 1987 to 1999 were evaluated retrospectively.Results: There were 64 patients with a mean age of 50 years. Primary tumor sites were 47 in the colon and 17 in the appendix. Peritoneal metastases were synchronous in 48 patients and metachronous in 16 patients. Patients received IP FUDR (1000 mg/m² daily for 3 days) and IP leucovorin (240 mg/m²) with a median cycle number of 4 (range, 1–28). The median number of complications was 1 (range, 0–5), with no treatment related mortality. Only six patients (9%) required termination of IP chemotherapy because of complications. The median follow-up was 17 months (range, 0–132 months). The median survival was 34 months (range, 2–132); 5-year survival was 28%. Lymph node status, tumor grade, and interval to peritoneal metastasis were not statistically significant prognostic factors for survival. Complete tumor resection was significant on multivariate analysis (P = .04), with a 5-year survival of 54% for complete (n = 19) and 16% for incomplete (n = 45) resection.Conclusions: Surgical debulking and IP FUDR for peritoneal metastases from colon cancer can be accomplished safely and has yielded an overall 5-year survival of 28%. Complete resection is associated with improved survival (54% at 5 years) and is the most important prognostic indicator.Presented in part at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.     

胃肠道癌术后腹腔静脉双途径化疗临床研究

目的 探讨腹腔内温热淋巴化疗联合静脉双途径化疗对提高生存率及防治腹膜复发和淋巴转移的作用。方法 38例侵及浆膜或有腹腔淋巴结转移的胃肠癌患者术后行温热腹腔淋巴化疗（腹腔化疗同时静脉点滴垂体后叶素）联合全身化疗（治疗组）；42例仅予温热腹腔内化疗＋全身化疗（对照组）而未行腹腔淋巴化疗。结果 治疗组患者1，2，3年生存率分别为97．4％，86．7％，78．9％；对照组为83．3％，73．8％，64．2％。治疗组患者1，2，3年生存率明显优于对照组，2组差异有统计学意义（P〈0．05）。治疗组患者3年内腹膜复发率15．3％，淋巴结转移率为18．4％，明显低于对照组42．1％，38．1％，2组差异有统计学意义（P〈0．05）。结论 温热腹腔淋巴化疗联合静脉双途径化疗可降低胃肠道肿瘤术后腹腔内及腹膜后淋巴转移率。提高术后生存率。     

胃肠肿瘤术后早期腹腔并全身化疗30例

 目的 研究术后早期腹腔内化疗与胃肠肿瘤术后生存率的关系。方法 用术后早期腹腔内化疗并MF全身化疗的方法治疗了30 例经病理确诊的胃肠癌中, Ⅲ～Ⅳ期占83 %.结果 在30 例病人中, 1、2 、5 年生存率分别为86-6 % , 63-3 % , 6-6 % , 其中2 例胃癌病人生存了6年。结论 术后早期腹腔内化疗并MF方案全身化疗对胃肠癌术后腹腔复发和肝转移有预防作用。     

腹腔热化疗对胃肠道恶性肿瘤患者T淋巴细胞亚群及SIL—2R水平的影响

目的:评估腹腔灌注热化疗(IPHC)对胃肠道恶性肿瘤患者免疫功能的影响.方法:对32例胃肠道恶性肿瘤患者术后腹腔灌注热化疗并测定外周血T淋巴细胞亚群(T-LS)和血清白细胞介素Ⅱ受体(SIL-2R)水平,与20例健康对照组进行比较.结果:行IPHC前,CD_3~ 、CD_4~ 、CD_8~ 、CD_4~ /CD_8~ 较对照组降低,SIL-2R升高,行IPHC后CD_3~ 、CD_4~ 、CD_8~ 、CD_4~ /CD_8~ 明显下降(P<0.01),SIL-2R降低(P<0.01).结论:腹腔灌注热化疗能明显提高患者免疫功能.     

Meconium peritonitis,intraperitoneal calcifications and cystic fibrosis

Twelve cases of meconium peritonitis were retrospectively reviewed in this study. Five of these patients had cystic fibrosis. Of the patients with cystic fibrosis, intraperitoneal calcifications were present in three (60%) and two (40%) had none. All seven patients (100%) who had abconium peritonitis without cystic fibrosis had abdominal calcifications. There results indicate that the presence of intraperitoneal calcification does not exclude the diagnosis of cystic fibrosis and that the absence of calcification favors cystic fibrosis. However, a review of the literature indicates the absence of calcification is merely of clue and not definitive as to the etiology of the meconium peritonitis.     

Laparoscopic management of incisional hernias ≥15 cm in diameter

Background  Despite good results in terms of safety and minimal recurrence ensured by laparoscopy in the management of incisional hernias, the use of minimally invasive techniques for large incisional wall defects is still controversial. Methods  Between 2002 and 2008 as many as 36 patients with abdominal wall defects ≥15 cm were managed laparoscopically in our institution. The wall defects were ≥20 cm in eight cases. The diameter of parietal defects was measured from within the peritoneal cavity. None had loss of domain. Body mass index (BMI) for 18 patients was ≥30 kg/m². Results  The mean duration of operations was 195 ± 28 min (range 75–540). One patient needed conversion for ileal injury and massive adhesions. Post-operative complications occurred in nine patients; there were six surgical complications. Morbidity in obese and non-obese patients was not statistically different (p > 0.05). There was no postoperative death. Mean hospital stay was 4.97 ± 3.4 days (range 2–18). Mean follow up was 28 months (range 2–68) and only one hernia recurrence was observed. Conclusions  Minimum-access procedures can provide good results in the repair of giant incisional hernia. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm our promising results.     

经大鼠静脉和腹腔途径导入脂质体包埋质粒在肝脏靶向分布表达的影响

目的比较静脉途径和腹腔途径对脂质体包埋的目的基因在肝脏靶向分布表达的影响。方法将真核细胞表达质粒经脂质体包埋成复合物，分别经尾静脉注射和腹腔注射导入大鼠体内，通过原位杂交和免疫组化的方法观察目的基因在肝脏和其他脏器的分布表达。结果运用脂质体包埋的质粒ＤＮＡ经两种途径导入体内２４小时后均见明显表达，１周后逐渐下降，３周时仍有表达；均以肝脏为主要分布器官，但经静脉途径导入者，质粒ＤＮＡ在肝脏中的分布表达高于经腹腔途径导入者。结论经静脉途径导入的脂质体／质粒ＤＮＡ复合物在肝脏的靶向定位效果优于经腹腔途径的导入。     

腹腔内化疗和温热化疗治疗中晚期消化道恶性肿瘤

目的 探讨治疗中晚期消化器官肿瘤术后复发或转移的安全、可靠和有效疗法。方法 回顾分析83例患者的临床资料。57例病人术后行腹腔化疗(IPC)和腹腔热化疗(IHC)。结果 IPC及IHC的总有效率为73％。其1、3、5、>5年的生存率分别为98.8％、33.7％、17.9％和12.3％。并用生物制剂组疗效较佳。无肝硬化者腹水控制率100％。结论 IPC及IHC是提高中晚期消化器官恶性肿瘤疗效,防治术后复发、转移和恶性腹水的有效手段。     

肝癌腹水腹腔化疗的临床研究

目的 探讨腹腔化疗对肝癌伴张力性腹水的疗效。方法 晚期肝癌伴张力性腹水患者61例，随机分三组，A组26例采用腹水超滤浓缩自体腹腔回输联合腹腔内化疗；B组18例用治疗性放腹水联合腔内化疗；C组17例单纯治疗性放腹水。B超测定患者治疗前后腹水消退情况。结果 一疗程有效率为A组57．7％；B组44．4％；C组11．9％。腹水超滤浓缩自体腹腔回输联合腹腔化疗明显改善患者营养状况、肾功能、肾钠排泄及血浆肾素－血管紧张素－醛固酮代谢。结论 腹腔化疗对肝癌伴张力性腹水具有一定的疗效，腹水超滤浓缩自体腹腔回输联合腹腔内化疗是治疗肝癌伴力性腹水的一种安全、可靠、经济的方法。