Fujimoto S, Takahashi M, Mutou T, Kobayashi K, Toyosawa T, Kondoh K, Ohkubo H
Social Insurance Funabashi Center Hospital, Kailin Funabashi, Japan.
Cancer Treat Res. 1996;81:169-76. doi: 10.1007/978-1-4613-1245-1_14.
In an attempt to prevent postoperative intraperitoneal recurrence in patients with advanced gastric cancer and consequently to improve survival time, we treated patients with intraperitoneal hyperthermic perfusion (IPHP) using mitomycin C (MMC) combined with surgery. There were 60 patients with advanced gastric cancer who were treated with IPHP (long-term study) group, and the survival of this group was compared with the outcome in 52 patients with advanced gastric cancer treated with surgery alone (control group). To avoid or diminish side effects derived from scald injury of the peritoneal surface due to IPHP, 50 mg/kg of cimetidine was given intravenously just before administration of IPHP. For prophylaxis of anastomotic leakage, duodenostomy using a Foley catheter was performed. The 60 patients who were treated with IPHP lived longer than the 52 patients in the control group (p = 0.000610). The 3 year survival rate was 45 percent for the former compared with 16 percent for the latter. The intravenous administration of cimetidine just prior to IPHP protected the peritoneoserosal surface from scald injury, even though the heated perfusate exposure was at 44.3-46.3 degrees C for 2 hours. Because the intraabdominal pressure within the duodenum and jejunum was decompressed postoperatively through catheter duodenostomy and the peritoneoserosal surface was protected from scald injury caused by IPHP, anastomotic leakage in the study group was nil. Therefore, IPHP treatment plus aggressive surgery combined with pre-IPHP cimetidine administration are indicated for patients with advanced gastric cancer. The side effects of IPHP and postoperative morbidity can thus be reduced and a favorable outcome obtained.
为了预防进展期胃癌患者术后腹腔内复发，从而延长生存时间，我们采用丝裂霉素C（MMC）联合手术对患者进行腹腔热灌注（IPHP）治疗。有60例进展期胃癌患者接受了IPHP治疗（长期研究组），并将该组患者的生存情况与52例仅接受手术治疗的进展期胃癌患者（对照组）的结果进行比较。为避免或减少IPHP引起的腹膜表面烫伤所致的副作用，在进行IPHP治疗前静脉注射50mg/kg西咪替丁。为预防吻合口漏，采用Foley导管行十二指肠造口术。接受IPHP治疗的60例患者比对照组的52例患者存活时间更长（p = 0.000610）。前者的3年生存率为45%，而后者为16%。即使热灌注液暴露温度在44.3 - 46.3摄氏度持续2小时，在IPHP治疗前静脉注射西咪替丁也能保护腹膜浆膜表面免受烫伤。由于术后通过十二指肠造口导管使十二指肠和空肠内的腹内压得以减压，且腹膜浆膜表面免受IPHP引起的烫伤，研究组的吻合口漏发生率为零。因此，对于进展期胃癌患者，建议采用IPHP治疗加积极手术，并在IPHP治疗前给予西咪替丁。这样可以减少IPHP的副作用和术后发病率，并获得良好的治疗效果。
