胃癌根治术中腹腔内温热化疗的临床安全性研究

Clinical Safety of Intraoperative Peritoneal Hyperthermia-Chemotherapy during Radical Gastrectomy.

目的:探讨胃癌根治术中腹腔内温热化疗(IPHC)的临床安全性。方法:监测49例接受IPHC治疗的进展期胃癌病人术中体温及呼吸、循环生理指标的变化;比较IPHC组病人(49例)与对照组病人(79例)手术死亡率和并发症发生率的差异。结果:IPHC过程中,病人的血温和颅温均显著上升,但未达到危险程度;同时肺顺应性下降、气道压力升高,但术后均顺利恢复正常;呼气末二氧化碳持续升高并保持在较高水平;心率、心排指数(CI)逐渐上升,但每搏指数(SVI)并无变化;外周阻力指数(SVRI)显著下降,而平均动脉压(MAP)、中心静脉压(CVP)、肺动脉楔压(PAWP)及平均肺动脉压(MPAP)均先行上升,然后逐渐下降,术后恢复正常。IPHC组与对照组的手术死亡率无显著差异;IPHC组和对照组的并发症发生率分别为18.4%和11.4%,无显著差异;IPHC组的肾功能异常发生率为14.3%,显著高于对照组的3.8%(P<0.05);吻合口漏发生率两组间无显著差异。结论:IPHC虽对人体生理造成一定影响,但均在可控制范围之内;其临床应用安全可靠。

Objective:To evaluate the clinical safety of intraoperative peritoneal hyperthermia-chemotherapy(IPHC)during radical gastrectomy.Methods:Data of body temperature,respiratory and circulatory system data were collected in49advanced gastric cancer patients treated by IPHC.Their morbidity and mortality rates were compared with that of79surgically treated controls without IPHC.Results:During IPHC,both the blood and the cranial temperature rose significantly without reaching a dangerous range;the compliance(Compl)decreased,while the pulmonary peak pressure(Ppeak)rose,both recovered uneventfully after operation.End-expiratory pressure of CO 2 (P ET CO 2 )rose steadily and remained at a high level after operation.The heart rate and cardiac index increased,but the strok valume index(SVI)did not show any significant alteration.Systemic vascular resistance index(SVRI)decreased significantly,but mean arterial pressure(MAP),central venous pressure(CVP),pulmonary artery wedge pressure(PAWP),and mean pulmonary artery pressure(MPAP)in creased at the beginning of IPHC,and decreased thereafter.There was no significant difference between the mortality rate of IPHC and control groups.The complication rate of IPHC and control groups was18.4%and11.4%respectively,without significant difference.The IPHC group had renal dysfunction rate of14.3%,the figure was significantly higher than3.8%in the control group(P<0.05).No significant difference existed between the2groups reganding anastomotic leakages.Conclusions:IPHC does produce some influence on human physiology,nevertheless,all the complications that might occur could be controlled,so the procedure could be applied clinically.