腹腔镜辅助持续循环腹腔热灌注化疗治疗恶性腹水

目的 探讨腹腔镜辅助持续循环腹腔热灌注化疗(continuous circulatory hyperthermic intraperitoneal chemotherapy,CHIPC)治疗恶性腹水的方法、可行性及临床初步疗效.方法 对2006年3月至2008年3月收治的21例恶性腹水患者应用腹腔镜辅助CHIPC,每例患者治疗3次,首次治疗在手术室内全麻醉下腹腔镜辅助完成,随后2次在病房或ICU内进行,持续循环灌注生理盐水500 ml/min,治疗温度43℃,灌注90 min,灌注药物根据原发病的不同而选择5-氟脲嘧啶加奥沙利铂(艾恒)或卡铂,对治疗效果进行随访,直至死亡.结果 21例患者手术均进行顺利,平均手术时间(80±18)min,无与腹腔镜辅助CHIPC技术相关的并发症发生.患者腹腔镜辅助CHIPC治疗后卡氏(Karnofaky,KPS)评分上升10～40分,平均上升(22.2±2.4)分(P＜0.01),19例患者腹水全部消失,2例部分缓解,有效率为100%,近期临床疗效满意.全部患者均获随访,随访时间1～9个月,中位随访时间6个月;中位生存期6个月,其中2例部分缓解患者术后出现戳孔种植转移,分别在治疗后1个半月及2个月死亡.结论 腹腔镜辅助CHIPC治疗恶性腹水可充分应用微创外科的优势,对消除恶性腹水、改善患者的生活质量具有较好的临床疗效.

Laparoscopic hyperthermic intraperitoneal chemotherapy (CHIPC) in the treatment of malignant ascites

Objective To evaluate laparoscopic continuous circulatory hyperthermic intraperitoneal chemotherapy (CHIPC) in the treatment of malignant ascites from peritoneal carcinomatosis.Methods From March 2006 to March 2008, 21 patients of malignant ascites secondary to peritoneal carcinomatosis received CHIPC with three courses of treatment for each patient. The first course was performed in operation room under general anesthesia, the second and third were performed in patients ward or intensive care unit (ICU), NS solution of mitomycin-C and cisplatin was delivered by continuous circulatary perfusion into peritoneal cavity at a rate of 500 ml/min for 90 min with an inflow temperature of 43 degrees C. Results Intraoperative course was uneventful in all cases, and mean operative time was (80 ± 18) min. There was no postoperative deaths and severe complications. After treatment patients KPS KPS (Karnofsky,KPS)grades rose from 10-40, with an average rise of (22.2 ± 2.4) (P ＜ 0.01). After laparoscopic CHIPC, clinical complete regression of ascites and related symptoms was achieved in 19 patients, and partial remission achieved in 2 patients. Follow-up was made to all patients until the death which occurred at post laparoscope-assisted CHIPC 1 - 9 months, with a median survival time of 6 months.Two patients who underwent partial remission suffered from port site seeding and tumor metastasis leading to death after treatment at 1 and 2 months respectively. Conclusions Laparoscopy-assisted CHIPC is effective for the treatment of malignant ascites from inoperable peritoneal carcinomatosis and improves the quality of life of these patients.