围手术期腹腔或盆腔热灌注化疗治疗结直肠癌的临床应用

Clinical application of perioperative continous hyperthermic peritoneal or pelvic perfusion chemotherapy for colorectal cancer

目的:探讨围手术期(术中和术后早期)腹腔或盆腔热灌注化疗治疗结直肠癌的可行性、安全性、毒副作用、并发症和短期抗癌疗效．方法:对我院住院治疗的20例进展期结直肠癌患者术中行根治性或姑息性切除术,术中对腹腔内肉眼可见转移癌灶尽量用电刀戳灭:结肠癌患者术中行腹腔热灌注化疗1次,术后前4 d,每日腹腔热灌注化疗1次,化疗液加热至43-44℃,循环灌注60-90 min,共5次;直肠癌患者术中盆腔热灌注化疗1次．结果:术中及术后早期行腹腔或盆腔热灌注化疗成功率为100%,热化疗时间内腹腔内化疗液温度均可达到41-43℃,并恒定保持60-90 min．热灌注化疗期间患者生命体征无明显异常,除暂时性发热、腹胀、腹痛外无其他不适,直肠癌患者盆腔少量出血1例,切口愈合延迟1例,无其他明显毒副作用及并发症．随诊率100%,随访3-27 mo．其中腹腔转移2例,盆腔转移1例,局部复发率为15%,肝转移1例,肝转移率5%;结肠癌、直肠癌患者中各有1例分别在术后14,10mo死于全身广泛转移．结论:围手术期腹腔或盆腔热灌注化疗结直肠癌安全可行,治疗不受环境限制,并可多次进行,毒副作用小,并发症少,可能有利于杀灭腹腔内残余微小癌灶(MC)和游离癌细胞(FCC)．

AIM： To evaluate the feasibility, safety, side effect, complications and short-term efficacy of perioperative （intraoperative and early postoperative） continuous hyperthermic peritoneal or pelvic perfusion chemotherapy （CHPPC） for colorectal cancer. METHODS： Radical or palliative resection was performed in 20 patients with advanced colorectal cancer. During the operation, macroscopic intraperitoneal metastases were demolished with electrosurgical unit （ESU）. The patients with colon cancer underwent CHPPC once using 5-fluorouracil （5-FU） and mitomycin during the operation, and then received 5-FU CHPPC onceper day from postoperative day 1 to 4. The hyperthermic perfusion lasted 60-90 minutes with a volume of 3000 mL at 43-44℃. The patients with rectal cancer were treated with intraoperative CHPPC （using 5-FU and mitomycin） once. RESULTS： The success rate of intraoperative and postoperative CHPPC was 100%, and the temperature during thermochemotherapy was maintained 41-43℃ for 60-90 minutes. There were no obvious changes in vital signs during perfusion except temporary fever, abdominal distention and pain. A little amount of hemorrhage in pelvic cavity occurred in 1 case with rectal cancer and incision healing delay was found in another case. All the cases were followed up for 3-27 months, of which 2 cases suffered from postoperative peritoneal recurrence （15%） and 1 was observed with hepatic metastasis （5%）. Two cases with colon cancer and rectal cancer, respectively, died of extensive metastasis on postoperative month 14 and 10. CONCLUSION： Perioperative CHPPC for colorectal cancer is safe and feasible, with fewer side effects and complications, and can be repeated without the restriction of therapeutic environment. Moreover, it may be beneficial to eliminating residual micro cancer and free cancer cells in patients following resection of colorectal tumors.