Raue W, Tsilimparis N, Bloch A, Menenakos C, Hartmann J
Department of General, Visceral, Vascular and Thoracic Surgery, Charité University Medicine Berlin, Campus Mitte, Berlin, Germany.
Eur Surg Res. 2009;43(4):365-72. doi: 10.1159/000248164. Epub 2009 Oct 17.
Surgical cytoreduction and simultaneous hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis is afflicted with a high incidence of postoperative complications. The knowledge of intraoperative volume therapy during surgery and chemotherapy is limited. On the other hand, the choice of a 'liberal' or 'restrictive' regimen of fluid administration has a deep impact on the postoperative morbidity. The aim of this observational trial was to report detailed data on volume replacement and cardiocircular function during the HIPEC procedure.
Eighteen consecutive patients undergoing cytoreductive surgery and HIPEC for peritoneal carcinomatosis were enrolled. The intraoperative volume administration was observed as well as the postoperative morbidity and mortality. Cardiofunctional data were assessed by the invasive transthoracic thermodilution technique.
The study showed that large amounts of volume (1,240 ml h(-1); range: 810-1,570 ml h(-1)) are given during the HIPEC procedure to replace fluid loss and maintain a stable circulatory function. Signs of a hyperdynamic status during intraoperative intraperitoneal chemotherapy were not found.
During surgical cytoreduction and simultaneous HIPEC, large amounts of volume were administered. HIPEC in itself did not lead to an increased fluid requirement. Further prospective studies with larger populations are needed to investigate whether goal-oriented therapies and a restricted volume regimen can contribute to decrease the postoperative morbidity.
手术细胞减灭术联合术中腹腔热灌注化疗（HIPEC）治疗腹膜癌病术后并发症发生率较高。手术及化疗期间术中容量治疗的相关知识有限。另一方面，“宽松”或“限制性”液体管理方案的选择对术后发病率有深远影响。本观察性试验的目的是报告HIPEC手术过程中容量补充及心脏循环功能的详细数据。
连续纳入18例因腹膜癌病接受细胞减灭术及HIPEC的患者。观察术中容量输注情况以及术后发病率和死亡率。通过有创经胸热稀释技术评估心功能数据。
研究表明，HIPEC手术过程中需输注大量液体（1240 ml·h⁻¹；范围：810 - 1570 ml·h⁻¹）以补充液体丢失并维持循环功能稳定。术中腹腔化疗期间未发现高动力状态的迹象。
在手术细胞减灭术联合HIPEC过程中，需输注大量液体。HIPEC本身并未导致液体需求量增加。需要进一步开展更大样本量的前瞻性研究，以探讨目标导向治疗及限制性容量管理方案是否有助于降低术后发病率。
