腹腔热灌注化疗在胃癌治疗规范化实施中的经验分享

Experience sharing of hyperthermic intraperitoneal chemotherapy in the standardized implementation of gastric cancer treatment

腹腔种植转移是晚期胃癌的一种转移形式,同时也是晚期胃癌患者的主要致死原因。基于“土壤-种子”学说,腹腔内存在游离癌细胞是胃癌腹膜转移的先决条件。因此,无论是发生腹膜转移的晚期胃癌患者,还是根治术后腹腔内可能存在游离癌细胞的进展期胃癌患者,有效清除腹腔内游离癌细胞是胃癌治疗的关键。近年来,腹腔热灌注化疗(hyper thermic intraperitoneal chemotherapy,HIPEC)由于具有药物热疗、机械冲刷和化疗的多重作用,已被广泛应用于临床,并且取得了较好的临床疗效。同时,多项研究证实HIPEC能够改善胃癌患者预后,降低术后腹膜转移的发生风险,此外也可改善已发生腹膜转移患者的预后,延长生存时间。本文通过总结河北医科大学第四医院既往临床实践经验,旨在建立规范化的HIPEC术中和术后操作流程和注意事项,为HIPEC的推广提供技术保障,使患者更好地获益。

Abdominal implant metastasis is a metastatic form of advanced gastric cancer,and it is also the main cause of death in patients with advanced gastric cancer.In view of the"soil-seed"theory,the presence of free cancer cells in the abdominal cavity is a prerequisite for peritoneal metastasis of gastric cancer.Therefore,whether it is for advanced gastric cancer patients with peritoneal metastasis or advanced gastric cancer patients who may have free cancer cells in the abdominal cavity after radical resection,the effective removal of free cancer cells in the abdominal cavity will be the key to gastric cancer treatment.In recent years,hyperthermic intraperitoneal chemotherapy(HIPEC)has been widely used in clinics due to its multiple effects of drug hyperthermia,mechanical washing and chemotherapy,and has achieved good clinical effects.Multiple studies have confirmed that HIPEC can better improve the prognosis of gastric cancer patients and reduce the risk of peritoneal metastasis after surgery.In addition,it can also improve the prognosis of patients with peritoneal metastasis and prolong survival time.This article summarizes the past clinical practice experience of the Fourth Hospital of Hebei Medical University,and aims to establish a standardized HIPEC intraoperative and postoperative operation process and precautions to provide technical support for its promotion,so that patients benefit better.