摘要
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。热稳定灌注组及对照组患者的平均肛门排气时间分别为(2.3±1.2)、(3.9±2.2)天(P=0.002),术后肠内营养起始时间(4.3±1.5)、(6.7±2.3)天(P<0.001),排便时间(5.2±2.1)、(7.1±2.9)天(P=0.004)。热稳定灌注治疗组患者术后疼痛评分(4.5±2.3),显著低于对照组(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,利于术后营养治疗的实施。
Objective The peritoneal carcinomatosis commonly occurs in late-staged gastrointestinal carcinoma. Combined cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC)have been widely accepted as effective palliative treatments for such patients. This study was designed to investigate whether a stable perfusion temperature during HIPEC could enhance bowel recovery after palliative surgery. Methods A consecutive series of 59 patients underwent CRS and HIPEC between January2012 and July 2013 were retrospectively reviewed. All patients were divided into study group with stable perfusion temperature and control group with unstable temperature according to the stability of perfusion temperature, After three cycles of HIPEC treatments, anal exhaust time, enteral nutrition initiation time,defecation time and postoperative pain(VAS score) were compared between the two groups. Results Thirtythree of 59(55.9%) patients underwent relatively stable hyperthermic perfusion treatments. Compared with those who had unstable perfusion temperature,The average anal exhaust time, enteral nutrition initiation time,defecation time were(2.3±1.2),(4.3±1.5) and(5.2±2.1) respectively in the study group, significantly shorter than(3.9 ±2.2),(6.7 ±2.3) and(7.1 ±2.9)days in the control group(P <0.01). The average VAS score was(4.5±2.3) in the study group, significantly less than(6.3±1.3) in the control group(P<0.001).Conclusion Stable perfusion temperature during HIPEC in gastrointestinal cancer patients with palliative surgery can promote bowel function recovery, reduce postoperative pain, and is beneficial to early initiation of subsequent enteral nutrition therapy.
出处
《消化肿瘤杂志（电子版）》
2014年第1期15-18,共4页
Journal of Digestive Oncology(Electronic Version)
基金
广东省自然基金(S2013020012724)
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
Gastrointestinal tumor
Peritoneal dissemination
HIPEC
Bowel function
Stable perfusion temperature
