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

Clinical efficacy and nursing experience of hyperthermic intraperitoneal chemotherapy in the treatment of advanced gastrointestinal tumors with peritoneal metastases

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。

Objective To investigate the therapeutic effect and nursing experience of hyperthermic intraperitoneal chemotherapy （HIPEC） for advanced gastrointestinal cancer with peritoneal metastases. Methods From January 2015 to December 2015 , 25 patients with advanced gastrointestinal cancer and peritoneal metastases were treated by HIPEC in our department. Complications and clinical effects of HIPEC were observed and nursing experience was summarized at the same time. Results Altogether 25 cases of patients completed HIPEC successfully. In short-term efficacy evaluation , complete remission was 80% （20/25）, partial remission was 20% （5/25）, and the total effective rate was 100%. No anastomotic leakage occurred after operation. The incidence of grade I-II bone marrow suppression was 20% （5/20）. Mild to moderate gastrointestinal side effects were observed in 36% （9/25） of patients. Postoperative gastrointestinal dysfunction accounted for 24% （6/25）. 80% （20/25） of patients had low serum albumin level. Wound infection and delayed healing accounted for 4% （1/25） of patients. Approximately 28% （7/25） of patients had ascites leakage around drainage tube. Nursing satisfaction rate was 92% （23/25）. Follow-up ranged from 4 to 15 months, the median survival time was 8.3 months. Conclusions HIPEC can effectively control the development of malignant ascites in advanced gastrointestinal tumors. Strictly standardized nursing can improve the safety of HIPEC, reduce the incidence of complications, and improve patient satisfaction.