恶性肿瘤术中腹腔热灌注化疗职业暴露的防护研究

Protection of Occupational Exposure to Intraoperative Hyperthermic Intraperitoneal Chemotherapy in Malignant Tumors

目的分析恶性肿瘤术中腹腔热灌注化疗时药物的逸散情况,探讨职业暴露防护的措施。方法2016年4月至2017年12月,便利抽样法选取在中国医学科学院肿瘤医院手术室接受腹腔热灌注化疗的恶性肿瘤患者40例为研究对象。按手术时间的先后将其分为对照组和观察组,每组20例。对照组采用常规防护方法,即常规佩戴手术室专用衣帽、佩戴一次性口罩及乳胶手套等;观察组采用改良的防护方法,即采用垂直层流生物安全柜、防水隔离衣、面罩等。比较两种防护下,医护人员手套、耳廓擦拭样本以及口罩中心部位化疗药物的阳性率及残留浓度。结果残留顺铂浓度检测显示,两组样本总体阳性率及口罩样本的阳性率差异均有统计学意义(均P<0.05)。在手套样本、耳廓擦拭样本或口罩样本上,残留药物的浓度差异无统计学意义(均P>0.05)。结论配置HIPEC药物过程中存在着化疗药物逸散的情况,需采用严密的防护措施以降低化疗药物的残留浓度。医院应该在手术室内配置生物安全柜,并严格按照标准作业程序执行。

Objective To investigate and analyze the dispersion of chemotherapeutic drugs during hyperthermic intraperitoneal chemotherapy (HIPEC) for malignant tumor,and to explore the protective measures of occupational exposure. Methods From April 2016 to December 2017,40 patients with malignant tumors receiving HIPEC in the operating room of Cancer Hospital were selected by convenience sampling method.According to the operation time,the patients were divided into control group and observation group,with 20 cases in each group.The control group was treated with routine protective methods,such as wearing the operating room clothes and hats,disposable masks and latex gloves,etc.The observation group adopted improved protection methods,namely vertical laminar flow biological safety cabinet,waterproof isolation clothing, mask and so on.The positive rate and residual concentration of chemotherapeutic drugs in gloves, ear wiping samples and the central part of masks were compared under the two protections. Results The detection of residual cisplatin concentration showed that there were significant differences in the overall positive rate and the positive rate of masks between the two groups ( P <0.05).There was no significant difference in the concentration of residual drugs among glove samples,ear wiping samples or mask samples (all P >0.05). Conclusions There is evaporation of chemotherapeutic drugs in the process of deploying HIPEC drugs.Strict protective measures should be taken to reduce the residual concentration of chemotherapeutic drugs.Hospitals should install biosafety cabinets in operating rooms and strictly follow standard operating procedures.