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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 investigate the clinical safety of intraperitoneal hyperthermic chemotherapy (IPHC) in radical resection of gastric cancer. Methods: The changes of body temperature and respiratory and circulatory indexes in 49 patients with advanced gastric cancer undergoing IPHC were monitored. The mortality and complication rates of 49 patients with IPHC and 79 patients with control group were compared difference. Results: During the course of IPHC, the blood temperature and cranial temperature of patients increased significantly, but did not reach the dangerous level. At the same time, the lung compliance decreased and the airway pressure increased, but returned to normal after operation successfully. The end-tidal carbon dioxide (CI) increased gradually, but the stroke index (SVI) had no change; the peripheral resistance index (SVRI) decreased significantly, mean arterial pressure (MAP) and central venous pressure ), Pulmonary arterial pressure (PAWP) and mean pulmonary arterial pressure (MPAP) both increased first, then gradually decreased and returned to normal after operation. There was no significant difference in operative mortality between IPHC group and control group. The incidence of complications in IPHC group and control group were 18.4% and 11.4% respectively, with no significant difference. The incidence of renal dysfunction in IPHC group was 14.3% 3.8% of the control group (P <0.05). There was no significant difference between the two groups in the incidence of anastomotic leakage. Conclusion: Although IPHC has a certain impact on human physiology, it is within the controllable range; its clinical application is safe and reliable.