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腹腔热灌注化疗技术在腹膜假性黏液瘤治疗中的应用
腹膜假性黏液瘤(pseudomyxoma pefitonei,PMP)是一种少见的以黏液外分泌细胞在腹膜种植并产生大量胶冻样黏液为特征的疾病[1].在临床外科上,将其分为原发性和继发性两种,继发性较原发性多见.继发性主要源于阑尾黏液囊肿、卵巢黏液性囊腺瘤或囊腺癌,为一种低度恶性病变.产生黏液的腺癌或囊肿原发瘤破裂后瘤细胞不经淋巴管或血管扩散,而种植于腹膜或腹腔脏器表面形成弥漫性转移灶,一般不发生脏器实质性浸润.病灶破裂聚集于腹腔中成为胶样黏液,导致腹腔广泛种植并不断产生黏液性物质,纤维组织增生产生广泛粘连[2].目前,临床上无特异性治疗方法,主要是通过手术去除病因,即设法根除卵巢、阑尾等病变,并尽可能清除腹腔内黏液物质.但该病在术后极容易复发,如何降低患者术后复发率,减少再次手术的可能性,提高患者的生存质量和生存率已成为困扰国内外学者的一大难题.1980年,国外学者Spratt等[3]根据肿瘤组织与正常组织的细胞对温度不同的耐受性和热化疗的协同效应,同时结合腹腔解剖学的特点,设计了一种新的化学治疗(化疗)技术--腹腔热灌注化疗技术(hyperthermic intraperitoneal chemotherapy,HIPEC),并应用该技术在治疗腹腔肿瘤中取得了突破.而Sugarbaker[4]将该项技术成功地运用于PMP的治疗中,并取得了理想的效果.本文就HIPEC在治疗PMP中的应用作一综述.
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腹腔热灌注化疗及其在胃肠道恶性肿瘤治疗中的应用
近年来,胃肠道恶性肿瘤发病率呈上升趋势.胃癌、结直肠癌、腹膜假性粘液瘤等患者手术后易出现腹腔种植转移并引起恶性腹水.尽管各种诊断和治疗技术不断提高,但仍有不少患者确诊时或术后很快出现腹腔内广泛种植转移[1],临床治疗十分棘手.腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)作为一种新兴的恶性肿瘤辅助治疗手段,在预防和治疗腹腔恶性肿瘤腹腔内种植转移及其伴发的恶性腹水方面具有独到的优势.现将HIPEC在胃肠道恶性肿瘤治疗中的应用现状作一简要综述.
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持续腹腔热灌注化疗
腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)作为一种新兴的恶性肿瘤辅助治疗手段,在预防和治疗腹腔恶性肿瘤腹腔内种植转移及其伴发的恶性腹水方面具有独到的优势.本视频主要演示腹腔热灌注化疗的方法.
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低渗热灌注腹腔化疗治疗胃肠肿瘤恶性腹水的临床研究
Background:Malignant ascites,a commonly severe complication of gastrointestinal tumors,influence the quality of life and survival time of patients.A number of studies showed Intraperitoneal chemotherapy by hyperthermal perfusion with hot hypotonic liquids with unique drug kinematics was effective in treating primary and secondary tumors of abdominal cavity and preventing the metastasis.
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Objective: To compare the pharmacokinetics of the routine intraperitonealchemotherapy (RIP) and continuous washing intraperitoneal chemotherapy (CWIP) of cisplatin(CDDP) in 38 patients with ovarian cancer. Methods: The patients had a performance status ofⅡ -Ⅳ on the FIGO scale.38 patients were randomized into CWIP group (16 patients) and RIP group(22 patients). CDDP was used as intraperitoneal chemotherapy (IP) with 70mg/m2. In 72h, thesamples from serum, ascites and urine were collected respectively and their platinum density weredetermined with electrochemistry polarographic analysis. On the third day and one month after IP,liver and kidney function and blood routine were examined. Results: The maximum concentration(Cmax) of plasma in CWIP and RIP groups were 3.84μg/ml and 1.27μg/ml respectively;the Cmaxof ascites were 7.04μg/ml and 4.43μg/ml respectively in the two groups. The area under the plas-ma concentration-time curve(AUC) in CWIP and RIP groups were 1067.77μg. h/ml and 191.72μg.h/ml respectively,and 1299.02μg. h/ml and 584.43μg. h/ml in ascites,their statistics dif-ference were significant ( P < 0.05). Conclusion: CWIP is better than the RIP in the pharmacoki-netics, while its side-effects is not increased. The new methods may be used on the patients.
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单次穿刺法在卵巢癌患者腹腔化疗中的应用
在卵巢癌的综合治疗中,腹腔化疗已广泛应用于临床.常用的腹腔灌注药物方法有传统的导管法及近年采用的单次穿刺法.我院近年采用单次穿刺法给药,获得了满意疗效.
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细胞减灭术联合腹腔热灌注化疗在恶性肿瘤治疗中的应用
细胞减灭术(cytoreductive surgery,CRS)联合腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)作为治疗进展期胃癌、结直肠癌、卵巢癌、腹膜假性黏液瘤等腹腔恶性肿瘤并腹水的有效措施引起了国内外学者的广泛关注.以往单纯的CRS通常只能处理肉眼可见病灶,而CRS联合HIPEC则综合利用手术、区域化疗、热疗和大容量液体的灌洗作用,清除和消灭腹腔内游离的癌细胞和微小癌灶,是目前恶性肿瘤的新型治疗模式.本文旨在对CRS联合HIPEC在恶性肿瘤中的临床应用研究进展作一简要综述.