在细胞还原性手术和高热性腹膜内化学疗法中,对毒性的外科治疗方法
1Department of Anesthesiology and Reanimation, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul 34764, Türkiye. goksust@gmail.com.
World journal of gastrointestinal surgery
|November 3, 2025
概括
带有高热性腹腔内化疗 (CRS + HIPEC) 的细胞还原性手术可能导致急性损伤 (AKI). 西斯普拉丁的使用,低流体摄入量,血管压力剂和手术前功能不佳是这些患者AKI的关键危险因素.
科学领域:
- 在瘤学瘤学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 手术瘤学手术瘤学
背景情况:
- 细胞还原性手术 (CRS) 与高热性腹膜内化学疗法 (HIPEC) 结合,是腹膜癌症 (PC) 的重要治疗方法.
- 在HIPEC中使用的内化疗剂具有严重的急性损伤 (AKI) 风险.
- 确定外科手术期间的风险因素对于减轻CRS + HIPEC患者的功能障碍至关重要.
研究的目的:
- 评估腹癌 (PC) 患者的术后结结果,这些患者接受了CRS + HIPEC.
- 在CRS + HIPEC之后,确定急性损伤 (AKI) 的独立预测因子.
主要方法:
- 一项回顾性队列研究包括了445名在2017年至2024年期间接受CRS + HIPEC治疗的患者.
- 收集的数据包括人口统计,手术前功能 (eGFR),HIPEC药物 (cisplatin,mitomycin C,oxaliplatin),手术内流体管理,血管压缩剂使用和术后肌素.
- AKI是使用KDIGO标准来诊断的,多变量逻辑回归确定了独立的风险因素.
主要成果:
- 急性损伤 (AKI) 在13.7% (61/445) 的患者中发生.
- 西斯普拉丁使用与最高的AKI率 (21.4%) 有关.
- 独立的AKI风险因素包括使用西斯普拉丁 (OR=2.8),手术内流体<6000毫升 (OR=2.1),血管压缩剂使用 (OR=1.9),以及手术前的eGFR<75毫升/分钟/1.73平方米 (OR=2.3). AKI延长了住院时间,其中0.7%进展为慢性病.
结论:
- 基于西斯的HIPEC疗法增加了AKI风险.
- 不充分的手术内液体注射和血管压缩剂的使用是AKI的重要风险因素.
- 术前功能评估对于术后规划至关重要,以尽量减少CRS+HIPEC后的AKI.
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