【摘要】 目的结合膀胱压力指标,研究腹腔热灌注化疗中灌注液使用的量与腹腔压力的关系。方法收集2018年6月～2019年3月本院胃肠外科行腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy,HIPEC）治疗的病例行HIPEC之前进行一般情况收集,并在热灌注时监测患者膀胱压与腹腔灌注液量的关系变化,并记录灌注期间的两根出水管路的通畅信息。结果期间我科共行收集有效相关HIPEC治疗病例32例,病因胃癌10例、卵巢癌7例、黏液癌6例、肠癌5例、腹膜癌3例,子宫内膜癌1例。男14例,女18例,中位年龄53岁（33～75岁）,通过这些病例的数据获得腹腔灌注液与膀胱压的趋势线:Y（Y为膀胱压,cmH₂O）≈1.067X+0.345X²（X为腹腔灌注液,L）。膀胱压为0～2.0 cm水柱时,盆腔引流管通畅率为46.9%,脾窝引流管通畅率为37.5%,两者无明显差异,两管均通畅率为21.9%。膀胱压为2.1～4.0 cm水柱时,盆腔引流管通畅率为78.1%,脾窝引流管通畅率为71.9%,两管均通畅率为65.6%,当膀胱压为4.1～6.0 cmH₂O或更高时两管均通畅率为100.0%。结论 HIPEC治疗过程中,承载主要作用的腹腔灌注液与腹腔压力存在二次函数关系。本研究发现,维持腹内压在4.1～6.0 cm以上时,能保证腹内灌注液的循环通畅。本研究为初步的单中心研究,仍需多中心的临床研究结果来验证。更多还原

【Abstract】 Objective To study the relationship between the volume of perfusion fluid used and the intraperitoneal pressure in hyperthermic intraperitoneal chemotherapy, in combination with the indexes of bladder pressure. Methods General conditions were collected before hyperthermic intraperitoneal chemotherapy（HIPEC） for patients undergoing HIPEC in our hospital from June 2018 to March 2019,the changes in the relationship between the bladder pressure and the intraperitoneal perfusion fluid volume were monitored during hyperthermic perfusion, and the unobfuscated information of two outlet pipelines during perfusion was recorded. Results During this period, our department collected 32 cases of effective HIPEC treatment in total, including 10 cases of gastric cancer,7 cases of ovarian cancer, 6 cases of mucinous cancer, 5 cases of intestinal cancer, 3 cases of peritoneal cancer, and 1 case of endometrial cancer. There were 14 males and 18 females, with a median age of 53 years old（33-75 years old）. From the data of these cases, the trend line of intraperitoneal perfusion fluid and bladder pressure was obtained: Y（Y stands for bladder pressure, cmH₂O）≈1.067 X+0.345 X²（X stands for intraperitoneal perfusion fluid, L）. When the bladder pressure was 0-2.0 cmH₂O, the patency rate of pelvic drainage tube and the patency rate of splenic fossa drainage tube were 46.9% and 37.5%, respectively. There was no significant difference between the two tubes, and the patency rate of both tubes was 21.9%. When the bladder pressure was 2.1-4.0 cmH₂O, the patency rate of pelvic drainage tube and the patency rate of splenic fossa drainage tube were 78.1% and 71.9%, respectively, and the patency rate of both tubes was 65.6%. When the bladder pressure was 4.1-6.0 cmH₂O or higher, the patency rate of both tubes was 100.0%. Conclusion During the HIPEC treatment, there is a quadratic function between the intraperitoneal perfusion fluid carrying the main function and the intraperitoneal pressure. This study finds that maintaining intraperitoneal pressure above 4.1-6.0 cm can ensure the circulation of intraperitoneal perfusion fluid unobstructed. This study is a preliminary single-center study, and results from a multicenter clinical study are still needed to verify the results.更多还原