Sugarbaker P H
Washington Cancer Institute, 110 Irving Street NW, Washington, DC 20010, USA.
Br J Surg. 2002 Feb;89(2):208-12. doi: 10.1046/j.0007-1323.2001.01967.x.
Cytoreductive surgery supplemented by perioperative intraperitoneal chemotherapy is a therapeutic option for selected patients with pseudomyxoma peritonei syndrome. In some patients, the stomach and/or its vascular supply are so covered by mucinous tumour that total gastrectomy is required for complete resection.
Forty-five patients underwent total gastrectomy with a temporary diverting jejunostomy as part of the surgical treatment of pseudomyxoma peritonei syndrome of appendiceal origin. Heated intraoperative intraperitoneal chemotherapy with mitomycin was used in all patients, and 36 had early postoperative intraperitoneal 5-fluorouracil. To date, 39 patients have had second-look surgery and stoma closure; 37 had additional perioperative intraperitoneal chemotherapy. A prospective database was maintained on all patients.
The median age was 47 (range 33-66) years. Median interval from diagnosis of pseudomyxoma peritonei to definitive cytoreductive surgery was 23 (range 0-140) months. Six patients presented with intestinal obstruction. The need for gastrectomy was predicted before operation by abdominal computed tomography. Mean operative time was 13 (range 9-17) h. Mean intraoperative requirement for packed red blood cells was 3.0 units, and that for fresh frozen plasma was 9.9 units. Six peritonectomy procedures, including total gastrectomy, were required for complete cytoreduction. All except seven patients were maintained on parenteral nutrition before second-look surgery for jejunostomy closure. All but two patients have resumed oral nutrition with discontinuation of parenteral feeding. There was one postoperative death and one late death. Thirty-seven patients are alive and disease-free, 0-56 months after initiation of treatment.
Total gastrectomy with a temporary diverting jejunostomy may be used to facilitate complete cytoreduction in patients with advanced pseudomyxoma peritonei syndrome.
减瘤手术联合围手术期腹腔内化疗是部分腹膜假黏液瘤综合征患者的一种治疗选择。在一些患者中，胃和/或其血管供应被黏液性肿瘤广泛覆盖，因此需要行全胃切除术以实现完全切除。
45例患者接受了全胃切除术并进行了暂时性空肠造口转流术，作为阑尾源性腹膜假黏液瘤综合征手术治疗的一部分。所有患者均采用术中丝裂霉素热灌注腹腔化疗，36例患者术后早期进行了腹腔内5-氟尿嘧啶化疗。迄今为止，39例患者接受了二次探查手术并关闭了造口；37例患者接受了额外的围手术期腹腔内化疗。对所有患者建立了前瞻性数据库。
中位年龄为47岁（范围33 - 66岁）。从诊断腹膜假黏液瘤到确定性减瘤手术的中位间隔时间为23个月（范围0 - 140个月）。6例患者出现肠梗阻。术前通过腹部计算机断层扫描预测了胃切除的必要性。平均手术时间为13小时（范围9 - 17小时）。术中平均浓缩红细胞需求量为3.0单位，新鲜冰冻血浆需求量为9.9单位。为实现完全减瘤，共进行了6例包括全胃切除术在内的腹膜切除术。除7例患者外，所有患者在二次探查手术关闭空肠造口前均接受肠外营养支持。除2例患者外，所有患者均已恢复口服营养并停止肠外营养支持。术后有1例死亡和1例晚期死亡。37例患者在开始治疗后0 - 56个月存活且无疾病复发。
全胃切除术联合暂时性空肠造口转流术可用于促进晚期腹膜假黏液瘤综合征患者的完全减瘤。
