腹壁化疗港在胃癌腹膜转移NIPS化疗应用中的安全性分析

Safety analysis of application of intraperitoneal chemotherapy port in NIPS chemotherapy for peritoneal carcinomatosis in gastric cancer

背景与目的:临床实践结果证实,针对胃癌腹膜转移患者进行腹腔内联合全身性化疗(NIPS)的疗效明显优于传统单纯全身性化疗。为了安全有效的进行腹腔内化疗,必须对腹壁化疗港进行合适的操作和管理。本研究探讨胃癌腹膜转移患者留置腹腔化疗港在进行腹腔化疗过程中存在的并发症及防治措施。方法:回顾性分析2018年1月—2020年6月行腹壁化疗港置入术行NIPS的胃癌患者临床资料,总结置入腹壁化疗港后出现的并发症、引起原因及处理措施。结果:共1634例胃癌患者进行腹腔镜探查联合腹腔脱落细胞学检测,结果发现腹膜转移者(P1CY1)137例(8.38%),腹腔脱落细胞学阳性(P0CY1)189例(11.57%)。326例患者术中均置入腹壁化疗港,术后进行腹腔内化疗的中位时间为11.6(0.9~26.3)个月。全组患者共出现与腹壁化疗港相关并发症共有57例(17.48%),其中以感染(5.21%)和导管折曲(2.15%)最为常见,其次是导管移位(1.84%)、港腔血肿(1.84%)、切口裂开(1.53%)、皮下硬结(1.23%)、导管阻塞(1.23%)、导管断裂(0.61%)、液体外渗(0.61%)、港座翻转(0.61%)、港腔种植转移(0.61%)。腹壁化疗港置入时间和出现并发症之间的中位间隔为5.4(0.3~13.4)个月。单因素分析发现,患者年龄、是否合并糖尿病、术者经验、术前是否贫血及低蛋白血症均是影响术后并发症发生的相关因素(均P<0.05)。多因素分析显示,经验<30例的术者(OR=8.317,95%CI=2.023~11.883,P=0.008)是影响腹壁化疗港置入患者术后出现相关并发症的独立危险因素。结论:腹壁化疗港在胃癌腹膜转移NIPS化疗中的应用是安全可行的,但引起并发症应引起重视,应就不同的并发症采取相应的预防和治疗策略,而具有丰富经验的专科术者是保障腹壁化疗港置入患者顺利渡过围术期的关键因素。

Background and Aims:The results of clinical practice confirmed that the effect of neoadjuvant intraperitoneal and systemic chemotherapy(NIPS)for peritoneal carcinomatosis in patients with gastric cancer is significantly superior to that of traditional lone systemic chemotherapy.In order to carry out the intraperitoneal chemotherapy safely and effectively,the intraperitoneal chemotherapy access port must be properly operated and managed.This study was conducted to explore the complications and preventive measures of intraperitoneal chemotherapy port placement in gastric cancer patients with peritoneal carcinomatosis.Methods:The clinical data of gastric cancer patients undergoing an intraperitoneal chemotherapy port placement for NIPS from January 2018 to June 2020 were reviewed,and the complications as well as their causes and treatment measures after intraperitoneal chemotherapy port placement were summarized.Results:A total of 1634 patients underwent laparoscopic exploration combined with cytological examination of abdominal cavity exfoliation,by which,137 cases(8.38%)were found having peritoneal metastases(P1CY1)and 189 cases(11.57%)were found to be positive for abdominal exfoliation cytology(P0CY1).All the 326 patients with peritoneal carcinomatosis underwent an intraperitoneal chemotherapy port placement during the operation,and the median time for intraperitoneal chemotherapy after the operation was 11.6(0.9-26.3)months.In the whole group of patients,complications associated with intraperitoneal chemotherapy port occurred in 57 cases(17.48%),among which,infection(5.21%)and bending or kinking of the catheter(2.15%)were the main complications,followed by catheter displacement(1.84%),port cavity hematoma(1.84%),incision dehiscence(1.53%),subcutaneous masses(1.23%),catheter obstruction(1.23%),catheter rupture(0.61%),fluid extravasation(0.61%),port turnover(0.61%),and port cavity tumor seeding(0.61%).The median interval between the intraperitoneal chemotherapy port placement and the occurrence of complications was 5.4(0.3-13.4)months.Univariate analysis found that the patient's age,presence of diabetes mellitus,experience of the surgeon,and preoperative anemia or hypoproteinemia were factors for the occurrence of postoperative complications(all P<0.05).Multivariate analysis showed that the surgeons with experience less than 30 cases(OR=8.317,95%CI=2.023-11.883,P=0.008)was an independent risk factor for postoperative complications in patients with abdominal wall chemotherapy.Conclusion:The application of intraperitoneal chemotherapy port in NIPS for peritoneal carcinomatosis of gastric cancer is safe and feasible,but attention should be paid to the associated complications,and corresponding prevention and treatment strategies should be adopted for different complications.A specialized operator with adequate experience is essential for ensuring patients undergoing an intraperitoneal chemotherapy port placement to uneventfully transition through the perioperative period.