持续腹腔热灌注治疗时热稳定对术后肠功能恢复的影响【已撤稿】
| 作者: |
1袁玉杰,
1宋武,
1徐建波,
1陈创奇,
1韩方海,
1蔡世荣,
1何裕隆
1 中山大学附属第一医院胃肠中心，广州 510080 |
| 通讯: |
何裕隆
Email: yulongh.sysu@gmail.com |
| DOI: | 10.3978/j.issn.2095-6959.2015.06.S006 |
摘要
【本文已撤稿，请勿继续引用】目的：消化道恶性肿瘤晚期患者术中探查多见全腹腔种植转移，术中姑息性切除并行术后腹腔热灌注治疗成为该期患者的重要治疗手段。本研究拟观察热灌注治疗过程中灌注温度的稳定性对术后肠功能恢复的影响。方法：回顾性分析2012年1月至2013年7月期间收治我科的晚期肿瘤患者。共计59例行减瘤术并腹腔热灌注治疗的患者符合入选标准。按热灌注温度稳定性将入选患者分为两组，灌注温度稳定在43 ℃的患者划归观察组，灌注期间温度较大波动的患者进入对照组。比较两组患者热灌注治疗后排气时间、肠内营养起始时间、排便时间、疼痛(VAS评分)等指标的差别。结果：59例晚期消化道肿瘤患者中共有33(55.9%)例患者灌注期间温度稳定。热稳定灌注组患者的平均排气时间较对照组明显提早(2.3±1.2 vs. 3.9±2.2 d，P=0.002)，而术后肠内营养起始时间(4.3±1.5 vs. 6.7±2.3 d，P<0.001)及排便时间(5.2±2.1 vs. 7.1±2.9 d，P=0.004)也均较对照组提前。此外，热稳定灌注治疗组患者术后疼痛较对照组患者显著减轻(4.5±2.3 vs. 6.3±1.3，P<0.001)。结论：腹腔热灌注治疗时维持灌注温度的稳定可有效减轻术后疼痛，促进肠道功能恢复，利于术后营养治疗地实施。
关键词：
胃肠肿瘤
腹腔种植转移
持续腹腔热灌注治疗
肠道功能
热稳定
Effect of stable perfusion temperature of hyperthermic intraperitoneal chemotherapy on bowel recovery in cancer patients with palliative surgery
DOI: 10.3978/j.issn.2095-6959.2015.06.S006
Abstract
Objective: The peritoneal carcinomatosis commonly occurs in end stage of various digestive malignances. Combined cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been widely accepted as effective palliative treatments for patients in end stage malignances. This study was designed to investigate whether a stable perfusion temperature could enhance bowel recovery after palliative surgery. Methods: A consecutive series of 59 patients underwent CRS and HIPEC between January 2012 and July 2013 were retrospectively reviewed. All patients were artificially divided into two groups according to the stability of perfusion temperature: study group with stable perfusion temperature and control group with unstable temperature. After three cycles of HIPEC treatments, flatus time, enteral nutrition initiation time, defecation recovery time and postoperative pain (VAS score) were utilized to compare bowel function recovery between the two groups. Results: In all, 33 of 59 (55.9%) patients underwent relatively stable hyperthermic perfusion treatments. Compared with those who had unstable perfusion temperature, the average flatus time (2.3±1.2 vs. 3.9±2.2 days, P=0.002) and time of enteral nutrition initiation (4.3±1.5 vs. 6.7±2.3 days, P<0.001) were significantly decreased in the study group, as well as the defecation recovery time (5.2±2.1 vs. 7.1±2.9 days, P=0.004). Besides, the average VAS score was markedly decreased (4.5±2.3 vs. 6.3±1.3, P<0.001). Conclusion: A stable perfusion temperature during the HIPEC therapy can promote bowel function recovery, reduce postoperative pain, and benefit the initiation of subsequent enteral nutrition therapy.