背景:阑尾腹膜假性黏液瘤(PMP),一种罕见的阑尾粘液肿瘤,用细胞减灭术(CRS)和腹腔热化疗(HIPEC)治疗。然而,HIPEC治疗过程中的管道堵塞是一个共同的挑战,阻碍治疗的顺利进行。迄今为止,很少有研究探讨阑尾PMP患者在HIPEC期间管闭塞的发生率和危险因素,以及其对术后并发症的不利影响。
方法:从2017年10月至2023年6月,共有80例阑尾PMP患者接受CRS和HIPEC联合治疗。严格定义了油管堵塞事件,分配给研究组的患者在HIPEC治疗期间遇到阻塞,而灌注通畅的患者被分配到对照组。在HIPEC后的健康评估和并发症的发生方面,对两组进行了比较分析。通过对303例HIPEC治疗的数据进行单变量和多变量分析,确定了封闭式HIPEC手术期间管腔阻塞的危险因素。
结果:41例(51.3%)患者发生油管堵塞。研究组胃肠减压时间延长(4.1±3.0vs.2.5±1.7天,P=0.003)和延长的排便时间(6.1±2.3vs.5.1±1.8天,P=0.022)与对照组相比。两组并发症发生率差异无统计学意义。术后1年生存率为97%,3年生存率为81%,在管道堵塞和较差的生存率之间没有发现关联。此外,在这80例患者中的303例HIPEC治疗中,89例(89/303,29.4%)发生管闭塞。多变量Logistic回归分析显示年龄,糖尿病,高血压,和病理作为管闭塞的独立危险因素。
结论:在HIPEC治疗期间,油管堵塞是常见的情况,导致术后胃肠功能恢复时间延长。当患者年老且合并有高血压和糖尿病时,伴随着组织学类型的低度粘液性肿瘤,管闭塞的风险增加。然而,这项研究未发现管道堵塞与术后并发症发生率或患者总生存率之间存在显著相关性.
BACKGROUND: Appendiceal pseudomyxoma peritonei (PMP), a rare tumor from mucinous appendiceal origins, is treated with Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (
HIPEC). However, tubing blockages during
HIPEC treatment pose a common challenge, impeding the smooth progression of therapy. Few studies to date have explored the incidence and risk factors of tube occlusion during
HIPEC in patients with appendiceal PMP, as well as its adverse impact on postoperative complications.
METHODS: From October 2017 to June 2023, a total of 80 patients with appendiceal PMP undergoing combined CRS and HIPEC were included in this study. Tubing blockage events were strictly defined, with patients experiencing blockages during HIPEC treatment allocated to the study group, while those with unobstructed perfusion were assigned to the control group. A comparative analysis was conducted between the two groups regarding post-HIPEC health assessments and occurrence of complications. Risk factors for luminal occlusion during closed
HIPEC procedures were identified through univariate and multivariate analysis of data from 303
HIPEC treatments.
RESULTS: Tubing blockages occurred in 41 patients (51.3%). The study group experienced prolonged gastrointestinal decompression time (4.1 ± 3.0 vs. 2.5 ± 1.7 days, P = 0.003) and prolonged time to bowel movement (6.1 ± 2.3 vs. 5.1 ± 1.8 days, P = 0.022) compared to the control group. There was no significant difference in the incidence of complications between the two groups. The 1-year survival rate postoperatively was 97%, and the 3-year survival rate was 81%, with no association found between tubing blockage and poorer survival. Additionally, In 303 instances of HIPEC treatment among these 80 patients, tube occlusion occurred in 89 cases (89/303, 29.4%). Multivariable logistic regression analysis revealed age, diabetes, hypertension, and pathology as independent risk factors for tube occlusion.
CONCLUSIONS: Tubing blockages are a common occurrence during HIPEC treatment, leading to prolonged postoperative gastrointestinal functional recovery time. When patients are elderly and have concomitant hypertension and diabetes, along with a histological type of low-grade mucinous tumor, the risk of tube occlusion increases. However, this study did not find a significant correlation between tubing blockage and the incidence of postoperative complications or overall patient survival.