AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritone...AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparoscopeassisted perfusion catheters placing. The first session was completed in operative room under general anesthesia, 5% glucose solution was selected as perfusion liquid, and 1500 mg 5 fluorouracil (5FU) and 200 mg oxaliplatin were added in the perfusion solution. The second andthird sessions were performed in intensive care unit, 0.9% sodium chloride solution was selected as perfusion liquid, and 1500 mg 5FU was added in the perfusion solution alone. CHIPC was performed for 90 min at a velocity of 450600 mL/min and an in flow temperature of 43 ± 0.2℃.RESULTS: The intraoperative course was uneventful in all cases, and the mean operative period for laparoscopeassisted perfusion catheters placing was 80 min for each case. No postoperative deaths or complications related to laparoscopeassisted CHIPC occurred in this study. Clinically complete remission of ascites and related symptoms were achieved in 14 patients, and partial remission was achieved in 2 patients. During the followup, 13 patients died 29 mo after CHIPC, with a median survival time of 5 mo. Two patients with partial remission suffered from port site seeding and tumor metastasis,and died 2 and 3 mo after treatment. Three patients who are still alive today survived 4, 6 and 7 mo, respectively. The Karnofsky marks of patients (5090) increased significantly (P < 0.01) and the general status improved after CHIPC. Thus satisfactory clinical efficacy has been achieved in these patients treated by laparoscopic CHIPC. CONCLUSION: Laparoscopeassisted CHIPC is a safe, feasible and effective procedure in the treatment of debilitating malignant ascites induced by unresectable gastric cancers.展开更多
Malignant ascites is a common symptom in patients with peritoneal cancer. Current assumption is that anincreased vascular permeability and obstruction of lymphatic channels lead to the accumulation of fluid in the abd...Malignant ascites is a common symptom in patients with peritoneal cancer. Current assumption is that anincreased vascular permeability and obstruction of lymphatic channels lead to the accumulation of fluid in the abdominal cavity. This case report describes a severely symptomatic patient with malignant ascites. The previously healthy 73-year-old male was presented with abdominal distention causing respiratory distress. Computed tomography revealed large amounts of ascites, a recto-sigmoidal mass with locoregional lymphadenopathy and an omental cake. Biopsy taken during colonoscopy revealed an adenocarcinoma of the colon with signet cell differentiation. A widespread peritoneal carcinomatosis was found during a diagnostic laparoscopy. The extent of peritoneal disease rendered the patient not suitable for cytoreductive surgery with curative intent. The ascites proved to be refractory to ultrasound-guided paracentesis; thus, a decision was made to perform palliative hyperthermic intraperitoneal chemotherapy without cytoreductive surgery. Consequently, ascites production stopped, and the respiratory distress was relieved thereafter. The postoperative recovery was uneventful. Ascites recurred eight months later, and a second hyperthermic intraperitoneal chemotherapy procedure was performed. The patient was still alive at the time of writing, 16 mo after the initial diagnosis.展开更多
目的:评估腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)对腹腔游离癌细胞的杀灭作用,探索腹膜癌细胞学根治的可行性。方法:收集45例腹膜转移癌患者HIPEC前、后的腹腔灌洗液(或腹水)样本,分别行腹腔灌洗液细胞学(pe...目的:评估腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)对腹腔游离癌细胞的杀灭作用,探索腹膜癌细胞学根治的可行性。方法:收集45例腹膜转移癌患者HIPEC前、后的腹腔灌洗液(或腹水)样本,分别行腹腔灌洗液细胞学(peritoneal lavage cytology,PLC)检查;普通RT-PCR及实时定量RT-PCR检测CEA m RNA、CK20 m RNA;化学发光法检测HIPEC前、后患者血清肿瘤标志物CEA、CA125、CA19-9;分析各项指标HIPEC前、后的变化特点。结果:HIPEC前、后PLC检查阳性率分别为93.3%vs.24.4%(P<0.001);CEA m RNA阳性率分别为97.8%vs.84.4%(P=0.058);CK20 m RNA阳性率HIPEC前、后均为95.6%(P=1.000)。分别有32.5%和30.0%的患者HIPEC后CEA m RNA表达量、CK20 m RNA表达量较HIPEC前显著下降(均P<0.001)。HIPEC前、后CEA、CA125、CA19-9阳性率分别为50.0%vs.23.6%(P=0.016)、52.6%vs.47.4%(P=0.409)、36.8%vs.26.3%(P=0.121)。结论:HIPEC可有效杀灭腹腔游离癌细胞,为实现腹膜癌的细胞学根治提供了一个可行的方法。展开更多
目的：比较多西紫杉醇腹腔热灌注化疗与顺铂腹腔热灌注化疗治疗老年胃癌并恶性腹水的临床疗效。方法 KPS评分为50～70分的老年胃癌并恶性腹水患者80例随机分为观察组（多西紫杉醇腹腔热灌注化疗）40例和对照组（顺铂腹腔热灌注化疗）40...目的：比较多西紫杉醇腹腔热灌注化疗与顺铂腹腔热灌注化疗治疗老年胃癌并恶性腹水的临床疗效。方法 KPS评分为50～70分的老年胃癌并恶性腹水患者80例随机分为观察组（多西紫杉醇腹腔热灌注化疗）40例和对照组（顺铂腹腔热灌注化疗）40例，观察2组近期疗效、生活质量（ KPS ）评分、肿瘤标记物（ CEA、CA125、CA199）及不良反应。结果观察组总有效率为70．0％（28／40），高于对照组47．5％（19／40）（χ2＝4．178， P ＜0．05）；疾病控制率为87．5％（35／40），高于对照组的67．5％（27／40）（χ2＝4．588， P ＜0．05）。治疗前KPS评分观察组、对照组分别为（56．50±5．80）分、（56．25±6．28）分，治疗后分别为（66．50±9．49）分、（68．25±8．44）分，2组均较其治疗前明显提高（ t ＝－6．817、－5．942， P ＜0．05）。2组治疗后较治疗前CEA、CA125、CA199水平明显降低（观察组t ＝6．593、2．189、1．606， P ＜0．05；对照组t ＝6．125、2．099、1．897， P ＜0．05），但治疗前、治疗后2组间均无明显差异（治疗前t ＝0．213、－0．973、0．103， P ＞0．05；治疗后t ＝－0．422、－0．945、0．872， P ＞0．05）。观察组胃肠道反应发生率为17．5％（7／40），较对照组的37．5％（15／40）。明显降低（χ2＝4．013， P ＜0．05）。结论多西紫杉醇腹腔热灌注化疗治疗老年胃癌并恶性腹水的疗效好，能提高患者生活质量，降低肿瘤标记物水平，不良反应轻。展开更多
基金Supported by Funds for Breakthroughs in Key Areas of Guang-dong and Hong Kong Projects, No. 2006Z1-E6041funds for Guangdong Provincial Science and Technology Programs, No. 2009A030301013
文摘AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparoscopeassisted perfusion catheters placing. The first session was completed in operative room under general anesthesia, 5% glucose solution was selected as perfusion liquid, and 1500 mg 5 fluorouracil (5FU) and 200 mg oxaliplatin were added in the perfusion solution. The second andthird sessions were performed in intensive care unit, 0.9% sodium chloride solution was selected as perfusion liquid, and 1500 mg 5FU was added in the perfusion solution alone. CHIPC was performed for 90 min at a velocity of 450600 mL/min and an in flow temperature of 43 ± 0.2℃.RESULTS: The intraoperative course was uneventful in all cases, and the mean operative period for laparoscopeassisted perfusion catheters placing was 80 min for each case. No postoperative deaths or complications related to laparoscopeassisted CHIPC occurred in this study. Clinically complete remission of ascites and related symptoms were achieved in 14 patients, and partial remission was achieved in 2 patients. During the followup, 13 patients died 29 mo after CHIPC, with a median survival time of 5 mo. Two patients with partial remission suffered from port site seeding and tumor metastasis,and died 2 and 3 mo after treatment. Three patients who are still alive today survived 4, 6 and 7 mo, respectively. The Karnofsky marks of patients (5090) increased significantly (P < 0.01) and the general status improved after CHIPC. Thus satisfactory clinical efficacy has been achieved in these patients treated by laparoscopic CHIPC. CONCLUSION: Laparoscopeassisted CHIPC is a safe, feasible and effective procedure in the treatment of debilitating malignant ascites induced by unresectable gastric cancers.
文摘Malignant ascites is a common symptom in patients with peritoneal cancer. Current assumption is that anincreased vascular permeability and obstruction of lymphatic channels lead to the accumulation of fluid in the abdominal cavity. This case report describes a severely symptomatic patient with malignant ascites. The previously healthy 73-year-old male was presented with abdominal distention causing respiratory distress. Computed tomography revealed large amounts of ascites, a recto-sigmoidal mass with locoregional lymphadenopathy and an omental cake. Biopsy taken during colonoscopy revealed an adenocarcinoma of the colon with signet cell differentiation. A widespread peritoneal carcinomatosis was found during a diagnostic laparoscopy. The extent of peritoneal disease rendered the patient not suitable for cytoreductive surgery with curative intent. The ascites proved to be refractory to ultrasound-guided paracentesis; thus, a decision was made to perform palliative hyperthermic intraperitoneal chemotherapy without cytoreductive surgery. Consequently, ascites production stopped, and the respiratory distress was relieved thereafter. The postoperative recovery was uneventful. Ascites recurred eight months later, and a second hyperthermic intraperitoneal chemotherapy procedure was performed. The patient was still alive at the time of writing, 16 mo after the initial diagnosis.
文摘目的:评估腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)对腹腔游离癌细胞的杀灭作用,探索腹膜癌细胞学根治的可行性。方法:收集45例腹膜转移癌患者HIPEC前、后的腹腔灌洗液(或腹水)样本,分别行腹腔灌洗液细胞学(peritoneal lavage cytology,PLC)检查;普通RT-PCR及实时定量RT-PCR检测CEA m RNA、CK20 m RNA;化学发光法检测HIPEC前、后患者血清肿瘤标志物CEA、CA125、CA19-9;分析各项指标HIPEC前、后的变化特点。结果:HIPEC前、后PLC检查阳性率分别为93.3%vs.24.4%(P<0.001);CEA m RNA阳性率分别为97.8%vs.84.4%(P=0.058);CK20 m RNA阳性率HIPEC前、后均为95.6%(P=1.000)。分别有32.5%和30.0%的患者HIPEC后CEA m RNA表达量、CK20 m RNA表达量较HIPEC前显著下降(均P<0.001)。HIPEC前、后CEA、CA125、CA19-9阳性率分别为50.0%vs.23.6%(P=0.016)、52.6%vs.47.4%(P=0.409)、36.8%vs.26.3%(P=0.121)。结论:HIPEC可有效杀灭腹腔游离癌细胞,为实现腹膜癌的细胞学根治提供了一个可行的方法。
文摘目的：比较多西紫杉醇腹腔热灌注化疗与顺铂腹腔热灌注化疗治疗老年胃癌并恶性腹水的临床疗效。方法 KPS评分为50～70分的老年胃癌并恶性腹水患者80例随机分为观察组（多西紫杉醇腹腔热灌注化疗）40例和对照组（顺铂腹腔热灌注化疗）40例，观察2组近期疗效、生活质量（ KPS ）评分、肿瘤标记物（ CEA、CA125、CA199）及不良反应。结果观察组总有效率为70．0％（28／40），高于对照组47．5％（19／40）（χ2＝4．178， P ＜0．05）；疾病控制率为87．5％（35／40），高于对照组的67．5％（27／40）（χ2＝4．588， P ＜0．05）。治疗前KPS评分观察组、对照组分别为（56．50±5．80）分、（56．25±6．28）分，治疗后分别为（66．50±9．49）分、（68．25±8．44）分，2组均较其治疗前明显提高（ t ＝－6．817、－5．942， P ＜0．05）。2组治疗后较治疗前CEA、CA125、CA199水平明显降低（观察组t ＝6．593、2．189、1．606， P ＜0．05；对照组t ＝6．125、2．099、1．897， P ＜0．05），但治疗前、治疗后2组间均无明显差异（治疗前t ＝0．213、－0．973、0．103， P ＞0．05；治疗后t ＝－0．422、－0．945、0．872， P ＞0．05）。观察组胃肠道反应发生率为17．5％（7／40），较对照组的37．5％（15／40）。明显降低（χ2＝4．013， P ＜0．05）。结论多西紫杉醇腹腔热灌注化疗治疗老年胃癌并恶性腹水的疗效好，能提高患者生活质量，降低肿瘤标记物水平，不良反应轻。
