IPCH the basic steps of the treatment technology, as IPCH is a relatively new treatment technology is still in continuous improvement and exploration among the commonly used techniques and methods of operation more or less the same but the basic steps below to make a profile on this.
IPCH therapy basic steps, IPCH usually complete resection of gastrointestinal cancer was started immediately and the state still under anesthesia. First of all, patients with head ice bag, cold bags back pad, so that the temperature dropped to 31.0-32.0, which aims to avoid the nerve center of intra-abdominal heating adverse effects on the brain. Then at the left and right leap within the next compartment (input) and pelvic Douglas fossa (output) set of sterile silicone tube (diameter 0.8cm, diameter 1.Ocm) 3-5 root, connected to a thermostat perfusion drive, so that perfusion drive, piping and abdomen form a loop system. Operation should be noted: control of the abdominal cavity input and output perfusate temperature in the 44.0-49.0 and 41.0-43.0, respectively, between the constant temperature of the liquid inside the abdominal cavity in 43.0, to ensure optimal efficacy and safety of the state. usually IPCH treatment time at 1-2h, so the choice of chemotherapy drugs should not be dependent on the cell cycle, and to have a direct cytotoxic effect of drugs is appropriate, such as MMC, CDDP or etoposide celecoxib (etoposide) and so on.
Capacity choice: liquid containing high concentrations of anti-cancer evenly distributed in the abdominal cavity so that the whole surface of the peritoneal cavity and abdominal organs in contact with them is the basis of intraperitoneal chemotherapy. In order to perfusion fluid and peritoneal surface contact area sufficient to give full play to IPCH surface effect (surface reaction), often used in clinical abdominal Expander (peritoneal cavityexpander, PCE), and an open perfusion, intraperitoneal infusion of fluid to 10L or more, thereby greatly increasing the peritoneal surface and the liquid contact area, to avoid memory IPCH intraperitoneal infusion of "dead space." According to fluid dynamics studies have shown that peritoneal fluid, only to intraperitoneal injection of large fluid expands to ensure the surface of abdominal viscera and the peritoneal fluid in contact with anti-cancer drugs. Rosensheir other fluid in the peritoneal perfusion peritoneal fluid injection of radioactive tracer study found that at least peritoneal perfusion 2OOOml liquid to overcome resistance to the free flow of fluid to ensure uniform distribution of fluid in the abdominal cavity. So, open intraperitoneal perfusion with a perfusion volume, uniformity and good benefits, but there are also easy to pollution, health care workers in direct contact with chemotherapy drugs, and must be carried out other shortcomings in the operation. Closed peritoneal perfusion can overcome these disadvantages, and can be repeated, but perfusion is limited, poor uniformity. To solve these problems, in a closed perfusion pressure within the abdominal cavity is trying in the hope that can be closed over a large number of intraperitoneal infusion of liquid, and to perfusion fluid in the abdominal cavity evenly.
Drug choices: intraperitoneal chemotherapy solution mainly composed of anti-cancer drugs and solvents. Isotonic solution of the more common applications, often saline solution or 1.5% Inpersol or Ringer solution. Hypertonic solution has enhanced the role of drug distribution, is currently attempts. Anticancer drug pharmacokinetics in the abdominal cavity as a guide, mainly based on the following options: drugs or their metabolites must pass their own kill tumor cells; drugs must have a low peritoneal permeability; drugs must be quickly cleared from plasma; drugs must have a strong ability to penetrate tumor tissue. According to the above principles, the most commonly used intraperitoneal chemotherapy of gastric cancer anti-cancer drugs are smooth lead (CDDP), mitomycin (MMC) and so on. A variety of chemotherapy drugs being carried out I, E of research, such as pins, lead oxaliplatin, gemcitabine, CPT-II and so on. There are currently macromolecules under the peritoneal clearance of small molecules slower than the characteristics of the application of intraperitoneal chemotherapy in a number of macromolecules of biological agents such as interferon, interleukin -2, monoclonal antibodies, to enhance anti-cancer treatment.
IPCH therapy basic steps in the implementation of IPCH the course of treatment should be closely observed with intraperitoneal hyperthermic vital organs under the influence of patients to ensure the safety of the treatment. Intraoperative monitoring of the focus is: change thy blood temperature: can be built by the pulmonary artery catheter or direct temperature measurement thermometer inserted in the lower esophageal indirect temperature measurement method, the temperature of blood flow due to heart shall not exceed 41 C, to ensure safety; cardiac function: including blood pressure, heart rate, cardiac function index (cardiac index, etc.; arterial partial pressure of oxygen and so on.