[Clinical application of intraperitoneal chemotherapy ports in patients with gastric cancer and peritoneal metastases].

Q3 Medicine
Z Zhang, S Lu, Y P Guo, F Bian, Y K Xu, X D Mo, H X Luo, X Y Tang, M Shi, J Zhang, C Yan, Y Chen, Z G Zhu
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引用次数: 0

Abstract

Objective: To evaluate the clinical value and safety of an intraperitoneal chemotherapy port technique in patients with gastric cancer and peritoneal metastases undergoing intraperitoneal chemotherapy. Methods: This was a retrospective, descriptive case analysis. From November 2022 to October 2024, patients diagnosed with gastric cancer and peritoneal metastases at Wuxi Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine with an expected survival >3 months, underwent laparoscopic exploration combined with implantation of an intraperitoneal chemotherapy port [PORT-A-CATH II system (Model 21-4055-24)] implantation. The procedure was as follows: (1) after laparoscopic exploration, a 4-cm skin incision was made at a predetermined site and a subcutaneous pocket created by dissecting to the muscle fascia and removing subcutaneous fat as needed to position the port septum 0.5-1.0 cm from the skin surface; (2) under direct laparoscopic visualization, the abdominal cavity was punctured and a guidewire inserted, followed by an 8.5 Fr sheath, through which a catheter with three trimmed side holes was placed after removal of the sheath; (3) the catheter length in the abdominal cavity was adjusted to 25-30 cm and the catheter trimmed, and connected to the port base, ensuring it extended beyond the connector's visible hole; (4) the whole port was placed within the subcutaneous pocket, and non-absorbable sutures used to create a double purse-string suture at the catheter's abdominal entry, forming an anti-reflux ring; (5) non-absorbable sutures were used to securely fix the port to the fascia through its four base holes and the exposed catheter segments on the fascia sutured and buried; (6) patency was confirmed by injecting saline and followed by intermittent skin closure provided there was no bleeding; and (7) the catheter tip was positioned in the pelvic cavity under laparoscopic guidance. Postoperatively, the patients underwent normothermic intraperitoneal and systemic treatment. The port infusion protocol involved disinfecting the skin (>10 cm diameter) around the port, confirming the puncture site, inserting a Huber needle vertically at 90° to the port base, infusing 100 mL saline to ensure patency, followed by continuous infusion of 1000 mL paclitaxel solution, and sealing with 20 mL saline before removing the needle. No saline flushing was required between chemotherapy infusions. The primary outcomes were the incidence and management of complications post-port implantation. Results: The study cohort comprised 225 patients with gastric cancer and peritoneal metastases. Using standardized port implantation and postoperative puncture procedures, the complication rate during follow-up was 14.2% (32/225), including effusion in 14 patients (6.2%), port infection in 10 (4.4%), incision dehiscence in four (1.8%), port inversion in two (0.9%), hematoma in one (0.4%), and catheter rupture in one (0.4%). Seventy-five percent (24/32) of patients with complications recovered and continued using the port after conservative treatments (e. g., aspiration of effusions, antibiotic therapy, incision management), whereas the remaining 25.0% (8/32) with complications required surgical removal of the port because the treatment was ineffective. The presence of preoperative ascites (P=0.019) and peritoneal cancer index score>15 (P=0.038) were significantly associated with development of complications. Conclusions: Our standardized procedure for intraperitoneal chemotherapy port implantation is safe and feasible for patients with gastric cancer and peritoneal metastases, having a low overall complication rate. Most complications can be successfully managed with conservative treatment, the device thus providing reliable support for intraperitoneal chemotherapy.

【腹腔内化疗端口在胃癌及腹膜转移患者中的临床应用】。
目的:探讨腹腔化疗技术在胃癌及腹膜转移患者腹腔化疗中的临床应用价值及安全性。方法:回顾性、描述性病例分析。2022年11月至2024年10月,在上海交通大学医学院瑞金医院无锡分院诊断为胃癌并腹膜转移的患者,预期生存期为bbbb3个月,行腹腔镜探查联合腹腔内化疗口(port - a - cath II系统(Model 21-4055-24))植入术。操作步骤如下:(1)腹腔镜探查后,在预定部位切开4 cm皮肤,根据需要解剖至肌筋膜并去除皮下脂肪,形成皮下袋,使中隔离皮肤表面0.5-1.0 cm;(2)在腹腔镜直视下,穿刺腹腔,插入导丝,然后插入8.5 Fr护套,取出护套后置入带3个修剪侧孔的导管;(3)调整腹腔内导管长度至25-30 cm,并修剪导管,与端口底座连接,确保其延伸到连接器可见孔之外;(4)将整个导管口置于皮下袋内,用不可吸收缝合线在导管腹部入口处形成双荷包缝合,形成抗反流环;(5)采用不可吸收缝合线将端口通过其4个基孔牢固地固定在筋膜上,将暴露在筋膜上的导管段缝合掩埋;(6)注射生理盐水确认通畅,在无出血的情况下进行间歇性皮肤闭合;(7)在腹腔镜引导下将导管尖端置于盆腔内。术后,患者接受了恒温腹腔和全身治疗。端口输注方案:对端口周围皮肤(直径约10 cm)进行消毒,确认穿刺部位,Huber针与端口底座垂直90°插入100 mL生理盐水确保通畅,随后持续输注1000 mL紫杉醇溶液,用20 mL生理盐水密封后拔针。化疗输注之间不需要生理盐水冲洗。主要结果是移植后并发症的发生率和处理。结果:研究队列包括225例胃癌和腹膜转移患者。采用标准化的端口植入及术后穿刺操作,随访期间并发症发生率为14.2%(32/225),其中积液14例(6.2%),端口感染10例(4.4%),切口裂开4例(1.8%),端口内翻2例(0.9%),血肿1例(0.4%),导管破裂1例(0.4%)。75%(24/32)的并发症患者经保守治疗(如引流积液、抗生素治疗、切口管理)后恢复并继续使用该端口,而其余25.0%(8/32)的并发症患者因治疗无效而需要手术切除该端口。术前腹水的存在(P=0.019)和腹膜癌指数评分bbb15 (P=0.038)与并发症的发生显著相关。结论:我们的规范化腹膜内化疗口植入术对胃癌伴腹膜转移患者安全可行,总并发症发生率低。大多数并发症可以通过保守治疗成功控制,因此该装置为腹腔内化疗提供了可靠的支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
中华胃肠外科杂志
中华胃肠外科杂志 Medicine-Medicine (all)
CiteScore
1.00
自引率
0.00%
发文量
6776
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