乳腺癌改良根治术后创腔恒温持续循环热灌注治疗的可行性研究

Feasibility of constantly circulating hot perfusion treatment in the cavity after breast cancer modified radical surgery

目的恒温持续循环热灌注治疗已广泛用于胸、腹腔脏器肿瘤治疗,取得较满意效果。本研究乳腺癌改良根治术后应用恒温持续循环热灌注治疗的可行性。方法选取2014-02-01-2016-02-28河南大学第一附属医院(56例)和河南大学淮河医院(23例)行乳腺癌改良根治术的79例患者作为研究对象。采用BR-TRG-Ⅱ体腔热灌注治疗系统,配制无菌蒸馏水1 500mL,恒温43.5℃,共进行156次恒温持续循环热灌注治疗,观察治疗过程中患者的双侧腋温、双侧掌心温度、局部皮肤颜色、伤口局部渗液及漏液、伤口愈合情况和生命体征变化等,并进行统计学分析。结果治疗前后患侧腋窝温度分别为(36.8±0.2)℃和(37.5±0.2)℃,健侧腋窝温度分别为(36.9±0.2)℃和(36.9±0.2)℃,患侧与健侧相比差异有统计学意义,P<0.05。治疗前后患侧掌心温度分别为(36.8±0.2)℃和(37.1±0.2)℃,健侧掌心温度分别为(36.7±0.1)℃和(36.8±0.2)℃,双侧掌心温度变化差异无统计学意义,P>0.05。生命体征在治疗前、中、后差异均无统计学意义,P>0.05。热灌注治疗后24h创腔引流量<100mL,48h引流量<40mL,72h引流量<30mL,引流管均在1周内拔出。所有伤口均甲级愈合。29例皮肤厚度<3mm的患者,随皮肤温度升高出现局部皮肤发红,但无皮肤烫伤和坏死患者。14次出现伤口渗液,仅包扎敷料渗湿,无发现漏液及水肿。结论乳腺癌改良根治术后应用恒温持续循环热灌注治疗,对非治疗部位影响较小,不影响术后伤口愈合和生命体征,是一种安全可行的治疗方法,值得临床推广应用。

OBJECTIVE Temperature continuous loop heat treatment has been widely used in the treatment of thoracic and abdominal viscera tumor, getting satisfying results. This research focuses on the feasibility of applying continuous cycle of thermostatic hot infusion treatment after modified radical surgery in breast cancer. METHODS During recovery period for 79 patients with breast cancer who had received modified radical surgery,the cavity BR-TRG-lots a hot perfusion treatment system was applied to chest wall and auxiliary body cavity, with 1 500 mL distilled water at the temperature of 43.5 ~C for 156 constant temperature continuous cycle heat infusion therapy in total. During the process,record and analyze the temperature of bilateral axillary and palm, local skin colour, local drainage and discharge of the wound, condition of the recovering wound and the change of vital signs. Results Before and after the treatment, the temperature of affected side axillary was（36.8 ±0.2）℃ and （37.5 ±0.2）℃,respectively. The temperature of healthy axillary was （36.9±0. 2）℃ and （36. 9±0. 2）℃. The result was statistically significant, P〈0. 05. Before and after the treatment,the temperaure of palm of the affected side was （36.8±0.2） ℃ and （37.1±0.2）℃,respectively. Temperature of the palm of healthy side was （36.7±0.1）℃ and （36.8±0.2）℃. The result was not statistically significant, P〉0.05. The vital signs were not statistically significant before,during and after treatment,P〉0.05. After the treatment of thermal perfusion,the Cavity discharge after 24 h was 〈100 mL,the cavity discharge after 48 h was 〈40 mL,the cavity discharge after 72 h was 〈30 mL,and the drainage tube was pulled out in 1 week. All wounds healed in Grade A. Twenty-nine patients with skin thickness 〈3 mm were observed to have the symptom of increased skin temperature,local skin redness,but with no skin burn or necrosis. There were wound seepage for 14 times, treated with bandage, dressing and infiltration,with no leakage of fluid or edema. CONCLUSIONS Applying heat infusion treatment at constant temper- ature for continuous cycle after modified radical surgery to breast cancer has small effects on the healthy side, and does not affect healing of wound and vital signs. It is a safe and feasible treatment method, worthy of clinical popularization and ap plication.