不同防护方案在恶性肿瘤术中腹腔热灌注化疗药物配置中的应用研究

Application of different protection schemes in the configuration of intraperitoneal hyperthermic perfusion chemotherapy drugs in malignant tumor operation

目的分析手术室在生物安全柜内配置恶性肿瘤腹腔热灌注化疗(HIPEC)药物的逸散情况。方法采用便利抽样法,2018年2月—2019年10月,选取在中国医学科学院肿瘤医院手术室接受HIPEC的胃肠恶性肿瘤患者60例为研究对象。按手术时间的先后将其分为4组,每组各15例。对照组胃肠恶性肿瘤患者的HIPEC配置台面不设置任何保护;隔离垫组胃肠恶性肿瘤患者的HIPEC配置台面平铺上与台面同等面积的隔离垫;医用纱布组胃肠恶性肿瘤患者的HIPEC配置台面平铺上与台面同等面积的医用纱布;医用吸水纸组胃肠恶性肿瘤患者的HIPEC配置台面平铺上与台面同等面积的医用吸水纸。4组均对配置人员采用常规防护方法,即配置人员常规佩戴手术室专用衣帽、佩戴一次性口罩及乳胶手套等。比较各组台面样本、手套样本、耳郭擦拭样本和口罩样本化疗药物的阳性率及残留顺铂浓度。结果不同组别台面样本药物残留阳性率比较差异有统计学意义(P<0.01),其中隔离垫组、吸水纸组、医用纱布组台面样本阳性率低于对照组,差异有统计学意义(P<0.01)。不同组别手套样本、耳郭擦拭样本和口罩样本药物残留阳性率比较差异无统计学意义(P>0.05)。不同组别台面样本药物残留浓度比较差异有统计学意义(P<0.01),其中隔离垫组、吸水纸组、医用纱布组台面样本药物残留浓度低于对照组,差异有统计学意义(P<0.01)。不同组别手套样本、耳郭擦拭样本和口罩样本药物残留浓度比较差异无统计学意义(P>0.05)。结论使用隔离垫、医用纱布和医用吸水纸覆盖台面可以有效降低化疗药物在生物安全柜台面的残留浓度。

Objective To explore the dissipation of hyperthermic intraperitoneal chemotherapy(HIPEC)drugs configured in the biological safety cabinet in the Operating Room.Methods From February 2018 to October 2019,convenience sampling was used to select 60 patients with gastrointestinal malignancies who received HIPEC in the Operating Room of the Cancer Hospital of the Chinese Academy of Medical Sciences as the research object.Patients were divided into four groups according to the order of operation time,with 15 cases in each group.In the control group,there was no protection on the HIPEC configuration table for patients with gastrointestinal malignancies.In the isolation pad group,the HIPEC configuration table for patients with gastrointestinal malignancies was flat with an isolation pad of the same area as the table.In the medical gauze group,the HIPEC configuration table for patients with gastrointestinal malignancies was covered with medical gauze of the same area as the table.In the medical absorbent paper group,the HIPEC configuration table for patients with gastrointestinal malignancies was laid flat with medical absorbent paper of the same area as the table.The four groups all adopted conventional protection methods for the configuration staff,that was,the configuration staff routinely wore special clothing and hats of the Operating Room,wore disposable masks and latex gloves.The positive rate of chemotherapy drugs and the residual cisplatin concentration of each group of countertop samples,glove samples,auricle wipe samples and mask samples were compared.Results There was a statistically significant difference in the positive rate of drug residues in countertop samples from different groups(P<0.01).Among them,the positive rates of countertop samples in the isolation pad group,medical absorbent paper group,and medical gauze group were lower than that of the control group,and the difference was statistically significant(P<0.01).There was no statistically significant difference in the positive rate of drug residues in glove samples,auricle wipe samples and mask samples in different groups(P>0.05).The difference of drug residue concentration in countertop samples of different groups was statistically significant(P<0.01).Among them,the concentration of drug residue in countertop samples of the isolation pad group,medical absorbent paper group,and medical gauze group was lower than that of the control group,and the difference was statistically significant(P<0.01).There was no significant difference in drug residue concentration in glove samples,auricle wipe samples and mask samples in different groups(P>0.05).Conclusions Covering the table with isolation pads,medical gauze and medical absorbent paper can effectively reduce the residual concentration of chemotherapy drugs on the biosafety countertop.