腹腔热灌注化疗非机械堵管发生现状及影响因素分析

Current situation and analysis of factors affecting non-mechanical tube blockage during hyperthermic intraperitoneal chemotherapy

目的 了解腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)堵管(指非机械性)发生现状及其影响因素。方法 根据纳入和排除标准,回顾性收集2019年5月至2021年5月期间于四川大学华西医院胃肠外科行HIPEC的恶性肿瘤患者。通过查阅该医院的医院信息系统、灌注记录方法获取患者的相关资料以及灌注过程中的堵管发生情况。采用logistic回归分析HIPEC堵管发生的风险因素。结果 共纳入240例恶性肿瘤患者,行HIPEC期间有88例发生堵管,堵管发生率为36.7%。多因素logistic回归分析结果显示,年龄≥65岁(OR=2.142,P=0.016)、合并糖尿病(OR=2.326,P=0.007)、循环流速300~450 mL/min(OR=2.778,P=0.001)、有腹水(OR=2.192,P=0.020)及PCI≥20分(OR=4.380,P<0.001)增加HIPEC堵管发生的概率。结论 恶性肿瘤患者行HIPEC期间较易发生非机械性堵管,尤需对中老年人、合并糖尿病、低循环流速、存在腹水及高PCI得分的患者予以重点关注,便于及时预防及应急处理。

Objective To understand the current situation and factors affecting tube blockage non-mechanical during hyperthermic intraperitoneal chemotherapy(HIPEC).Methods According to the inclusion and exclusion criteria,the patients with malignant tumors who underwent HIPEC in the Department of Gastroenterology of West China Hospital of Sichuan University from May 2019 to May 2021 were retrospectively gathered.The information about the patient and the occurrence of occlusion during HIPEC were obtained by consulting electronic medical records and perfusion records.The logistic regression analysis was performed to analyze the factors influencing non-mechanical tube blockage during HIPEC.Results A total of 240 patients with malignant tumors were gathered.During HIPEC,the nonmechanical tube blockage occurred in 88 patients with malignant tumors,with the incidence of 36.7%.The multivariate analysis results by logistic regression showed that the probabilities of non-mechanical tube blockage during HIPEC were higher in the patients with age≥65 years(OR=2.142,P=0.016),diabetes mellitus(OR=2.326,P=0.007),perfusion speed of300–450 mL/min(OR=2.778,P=0.001),ascites(OR=2.192,P=0.020),and PCI≥20 points(OR=4.380,P0.001).Conclusions Patients with malignant tumors treated with HIPEC are prone to non-mechanical tube blockage.The patients with middle-aged and elderly,diabetes,low perfusion speed,ascites,and high PCI score need to be of great concern,so as to prevent and deal with tube blockage in time.