Soligo Chiara, Cenzi Carola, Foscaro Francesca, Bordignon Beatrice, Savi Susanna, Perdonò Paolo, Munaretto Gianni, Visentin Francesca, Tarantino Tommaso, Cerato Alberto, Pilati Pierluigi, Cabianca Roberta, Sommariva Antonio
Surgical Oncology of the Digestive Tract, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
Clinical Research Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
In Vivo. 2025 Jan-Feb;39(1):127-131. doi: 10.21873/invivo.13810.
BACKGROUND/AIM: During hyperthermic intra-peritoneal chemotherapy (HIPEC), perfusion instability (PI) is defined as the inability to maintain a proper perfusion flow without impairment of the target temperature. The management and resolution of this adverse event is underreported and poorly investigated. The study aimed to evaluate the incidence of PI during closed cytoreductive surgery (CRS)-HIPEC and how a problem-solving approach might limit the effects of this adverse event.
A retrospective analysis of patients who underwent CRS-HIPEC at our Institution was performed. PI was defined when the patient's outflow pressure of the circuit was not able to maintain target flow and temperature (1,100 ml/min and 41°C). A step-by-step problem-solving flowchart, which included checking the drain position, proper muscle relaxation, changing the bed position, adjusting the perfusion volume and switching the drain flow switch, was used.
A total of 208 HIPEC procedures were reviewed between May 2018 and January 2023. PI occurred in 21 cases (10.1%). Patients with PI had a significantly longer perfusion time (p<0.001). Although the mean outflow pressure and flow rate were significantly lower in patients with PI (p<0.001), the target temperature was maintained until the end of HIPEC.
A scheduled problem-solving approach by HIPEC perfusionist team was able to resolve most cases of PI. Further research on perfusion technical details and volume calculation is needed to prevent and limit the effects of this complication.
背景/目的：在腹腔热灌注化疗（HIPEC）期间，灌注不稳定（PI）被定义为在不影响目标温度的情况下无法维持适当的灌注流量。关于这一不良事件的管理和解决方法的报道较少，且研究不足。本研究旨在评估在根治性手术联合HIPEC期间PI的发生率，以及一种解决问题的方法如何可能限制这一不良事件的影响。
对在我们机构接受根治性手术联合HIPEC的患者进行回顾性分析。当患者回路的流出压力无法维持目标流量和温度（1100毫升/分钟和41°C）时，定义为发生PI。使用了一个逐步解决问题的流程图，包括检查引流管位置、适当的肌肉松弛、改变体位、调整灌注量和切换引流管流量开关。
在2018年5月至2023年1月期间共回顾了208例HIPEC手术。21例（10.1%）发生了PI。发生PI的患者灌注时间明显更长（p<0.001）。虽然发生PI的患者平均流出压力和流速明显更低（p<0.001），但目标温度一直维持到HIPEC结束。
HIPEC灌注团队采用预定的解决问题方法能够解决大多数PI病例。需要对灌注技术细节和容量计算进行进一步研究，以预防和限制这一并发症的影响。
