Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA.
Gynecol Oncol. 2011 Nov;123(2):342-5. doi: 10.1016/j.ygyno.2011.07.031. Epub 2011 Aug 15.
While intraperitoneal (IP) chemotherapy has shown significant survival benefits, the ability to successfully deliver IP chemotherapy has been limited. In GOG 172, surgically-placed IP catheters had a reported complication rate of 34%. In addition, IP catheters have to be placed surgically. We have developed a novel percutaneous placement technique for IP catheters in patients without ascites.
This study was a retrospective analysis of all patients receiving percutaneously-placed IP catheters from 12/2008 to present. Catheters were placed using a two-step technique under conscious sedation. IP access was gained using ultrasound-guided peritoneal puncture over the right lobe of the liver. A 5 Fr catheter was placed into the peritoneal cavity and the abdomen insufflated with carbon dioxide (CO(2)). Access was gained in the RLQ once distention separated the bowel from the abdominal wall. A 14.5 Fr multi-side hole catheter was coiled in the pelvis, and a reservoir tunneled onto the lower anterior chest wall. For this analysis, abstracted data included patient demographics, indication for catheter placement, complications (procedural and with chemotherapy delivery), fluoroscopy time, and timing/indication of catheter removal.
Eleven patients received IP catheters. The mean age was 58 years, mean body mass index was 27.1, and mean number of days from surgical debulking was 38. There were two stage 2, and eight stage 3 patients. Two patients had fallopian tube, and nine patients had ovarian cancer. All patients had an optimal debulking procedure. Seven of 11 patients also obtained central intravenous access when the IP port was placed. Follow-up data were as follows: Average fluoroscopy time was 9 min. One patient (9%) had an intra-procedural complication but the catheter was successfully placed. Zero patients had catheter-related complications in the course of receiving chemotherapy. Five of the 11 patients (45%) completed the planned IP chemotherapy treatments, with three additional patients (27%) currently receiving therapy. The remaining three patients (27%) discontinued chemotherapy for reasons unrelated to IP catheter function: two due to chemotherapy side effects, and one with sepsis from a perforated diverticulum.
Thus far, our experience with percutaneous placement of IP catheters is associated with a low risk of catheter-related complications and high technical success rates. CO(2) insufflation may make peritoneal puncture easier and potentially safer. This procedure offers an alternative to surgical placement, even in patients without clinically significant ascites.
腹腔内（IP）化疗已显示出显著的生存获益，但成功实施 IP 化疗的能力受到限制。在 GOG 172 中，手术放置的 IP 导管的并发症发生率为 34%。此外，IP 导管必须通过手术放置。我们已经开发了一种新的经皮放置 IP 导管的技术，用于没有腹水的患者。
这是一项对 2008 年 12 月至目前所有接受经皮放置 IP 导管的患者进行的回顾性分析。在镇静下，使用两步技术放置导管。通过超声引导下的肝右叶腹膜穿刺获得 IP 通路。将 5 Fr 导管放入腹腔，用二氧化碳（CO2）充气。一旦膨胀将肠与腹壁分离，就在 RLQ 获得通路。将 14.5 Fr 多孔侧导管盘绕在骨盆中，并将储液器隧道到下前胸壁。在这项分析中，提取的数据包括患者人口统计学、导管放置的适应证、并发症（程序和化疗输送）、透视时间以及导管移除的时间/适应证。
11 例患者接受了 IP 导管治疗。平均年龄为 58 岁，平均体重指数为 27.1，手术减瘤后平均天数为 38 天。有 2 例 II 期和 8 例 III 期患者。2 例患者为输卵管癌，9 例患者为卵巢癌。所有患者均进行了最佳的减瘤手术。11 例患者中有 7 例在放置 IP 端口时也获得了中心静脉通路。随访数据如下：平均透视时间为 9 分钟。1 例（9%）患者在程序中出现并发症，但导管成功放置。在接受化疗的过程中，没有患者出现与导管相关的并发症。11 例患者中有 5 例（45%）完成了计划的 IP 化疗治疗，另外 3 例（27%）患者目前正在接受治疗。其余 3 例（27%）患者因与 IP 导管功能无关的原因停止化疗：2 例因化疗副作用，1 例因穿孔憩室炎导致败血症。
迄今为止，我们经皮放置 IP 导管的经验与较低的导管相关并发症风险和较高的技术成功率相关。CO2 充气可能使腹膜穿刺更容易，并且潜在更安全。即使在没有临床显著腹水的患者中，该程序也为手术放置提供了替代方案。
