术中腹腔内温热化疗对胃肠道吻合口愈合影响的研究

Influence of intraoperative peritoneal hyperthermic chemotherapy on healing of gastrointestinal anastomosis

目的研究术中腹腔内温热化疗(IPHC)对胃肠道吻合口愈合的影响。方法(1)18头幼猪施行模似胃癌根治术,随机分为3组,每组6头。37℃常温灌注组(IPNP组):43℃温热灌注组(IPHP组);43℃温热化疗组(IPHC)组,化疗药物为丝裂霉素5mg/L。检测各组吻合口破裂压、羟脯氨酸含量、组织学和超微结构变化,评价IPHC对吻合口愈合的影响。(2)44例进展期胃肠道癌肿施行IPHC,另67例作为对照组,进一步研究IPHC的结果。结果(1)术后第14d,所有动物再次剖腹探查均未发现吻合口瘘。IPNP、IPHP及IPHC3组的胃肠道平均吻合口破裂压分别为31.5kPa、32.6kPa和31.0kPa(P>0.2);同样,羟脯氨酸含量分别为12.47μg/mg、13.68μg/mg和13.22μg/mg(P>0.1)。组织学检测显示各组胃肠道吻合口均愈合良好。(2)临床上IPHC组和对照组胃肠道吻合口瘘的发生率分别为2.3%(1/44)和4.5%(3/67)(P>0.05)。结论IPHC对胃肠道吻合口愈合没有不良影响。作为新的外科辅助疗法,IPHC是安全可行的。

Objective To investigate the influence of intraoperative peritoneal hyperthermic chemotherapy(IPHC) on healing of gastrointestinal anastomosis.Methods (1) A imitative radical gastrectomy was performed in 18 healthy infant swine . All the animals were randomly divided into three groups(n=6 each) and given different treatment as follows:Group A,37℃intraoperative peritoneal normothermoperfusion(IPNP) for 1 hour:Group B, 43℃intraoperative peritoneal hyperthermoperfusion(IPHP)for 1hour and Group C,43℃IPHC with MMC 5 mg/L for 1 hour . The influence of IPHC on healing of gastrointestinal anastomosis was studied by observing and comparing the anastomosis bursting pressure, hydroxyproline content, histopathologic and ultrastructure changes in different groups. (2) 44 cases of advanced gastrointestinal cancers were given IPHC treatment and other 67 cases as control.The results of IPHC were further analyzed. Results (1) At the 14th postoperative day,no anastomotic leakeage was found in all animals at the second look operaiton . The averaged anastomosis bursting pressure in Group A,B,C averaged 31.5 kPa,32.6 kPa and 31.0 kPa respectively (P>0.2),samely,the contents of hydroxyproline in each groups were 12.47 μg/mg,13.68 μg/mg and13.22 μg/mg respectively (P>0.1).The histopathologic observation showed well healing in all gastrointestinal anastomosis;(2) In the clinical IPHC group and the control group,the morbidity of gastrointestinal leakage was 2.3%(1/44) and 4.5%(3/67) respectively(P>0.05).Conclusions IPHC has no adverse effect on the healing of gastrointestinal anastomosis.As a new adjuvant surgical therapy,IPHC would be safe and feasible in the future clinical practice.