盆腔恶性肿瘤隔离热灌注化疗的体外循环管理(附1例报告)  

Management in extracorporeal circulation of hyperthermic isolated perfusion chemotherapy in the treatment of pelvic cancer(case report)

作　　者：李全正[1] 王雪延 

机构地区：[1]天津医科大学总医院心血管外科,天津300052

出　　处：《中国体外循环杂志》2015年第4期235-239,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结体外循环下盆腔隔离热灌注化疗的管理经验。方法对1例晚期宫颈鳞状细胞癌患者行体外循环下热灌注化疗,采用球囊导管阻断腹主动脉和下腔静脉、双侧大腿根部上止血带阻断下肢血流,以隔离盆腔血液循环,股动、静脉插管连接密闭式与开放式两用膜式氧合器开始行体外循环。体外循环管路内加入化疗药物同时变温水箱为血液持续加温,行盆腔隔离热灌注化疗,解除盆腔隔离前用超滤器滤除化疗药物。结果球囊导管插管及股动、静脉插管等手术操作顺利,体外循环中管路系统维持密闭式,过程平稳,总的转流时间90 min,流量12.8~22.2 ml/（kg·min）,膀胱温最高达39℃,盆腔之下（包括盆腔）隔离时间90 min,盆腔单独隔离时间70 min,下肢血流阻断时间70 min,超滤时间40 min,超滤量3 250 ml,其中零平衡超滤量2 500 ml、常规超滤750 ml。患者于手术室内拔除气管插管,术后恢复顺利,未见肝、肾损害或其它与化疗药物相关的并发症,术后7天出院,术后14天超声检查显示盆底肿瘤明显缩小。结论体外循环下盆腔隔离热灌注化疗治疗盆腔恶性肿瘤具有可行性,能有效抑制肿瘤进展。与常规体外循环不同,技术、设备及体外循环管理均很重要且有特殊性。Objective To summarize the experience with the management of pelvic cavity isolated perfusion chemotherapy（PIPC） by extracorporeal circulation（ECC）.Methods Recently 1 case of advanced cervical squamous cell carcinoma underwentECC assisted hyperthermic PIPC by balloon catheter occlusion both in abdominal aorta and inferior vena cava, and by bilateral thightourniquet to block lower extremity blood flow before ECC. After femoral artery and vein intubation and connecting the closed and opentype dual-purpose ECC system to the isolatied pelvic cavity mentioned above, ECC assisted hyperthermic PIPC began. During PIPCchemotherapy drugs were injected into the ECC system. Continuous blood heating was achieved by water from heater-cooler. Chemo-therapy drugs was cleared by ultrafiltration before removal of the pelvic cavity isolation.Results Intubation of balloon catheter andfemoral artery and vein cannulaswas smooth. ECC pipeline system maintained closed. The total ECC time was 90 min. ECC flow was 12.8 to 22.2 ml/（kg·min）. Bladder temperature reached 39.0 degrees andisolation time for regional pelvic below pelvis（including pel-vis） was 90 min whilst pelvic isolation time was 70 min and lower limb blood flow occlusion time was 70 min. The ultrafiltration time was40 min, ultrafiltration volume was 3250 ml, including zero balanced ultrafiltration volume of 2500 ml and conventional ultrafiltration of750 ml. Patient was extubated in the operating room, with postoperative recovery smoothly, with no injury of liver and kidney or otherchemotherapy related complications. The patient was discharged 7 days after operation. The 14- days postoperative ultrasonographyshowed that the pelvic floor tumor significantly shrinked.Conclusion Results from this case of ECC assisted hyperthermic PIPC in thetreatment of pelvic cancer showed that this therapeutic schedule is feasible and effective to inhibit tumor progression. Different from con-ventional ECC, The technique, equipment and ECC management are very important and spec

关 键 词：体外循环 隔离灌注 盆腔 癌 超热 化疗 

分 类 号：R739.9[医药卫生—肿瘤]