目的：探讨B超导向腹腔热灌注化疗（HIPEC）治疗恶性腹水的方法、可行性及临床初步疗效。方法：对本院2011年7月至2013年6月收治的36例恶性腹水患者应用 B 超导向 HIPEC共3次，持续循环灌注生理盐水400～600 mL／min，治疗温度（43±0．2）℃，灌注90 min，灌注药物选择5－氟尿嘧啶加丝裂霉素或卡铂，对其治疗效果进行长期随访。结果：36例患者治疗过程顺利，治疗后一般状况、精神状态好转，近期临床疗效满意。26例患者腹水全部消失，8例部分缓解，2例无效，有效率为94．44％。患者治疗后KPS评分上升（P ＜0．001）；肿瘤标志物下降，CA199（P ＜0．001）、CEA（P ＜0．001）、CA125（P ＝0．003）。结论：B超导向HIPEC可维持腹腔内灌注液体速度一致，维持腹腔内温度稳定，保证化疗药物与肿瘤的充分接触，具有创伤小、患者痛苦少、简便、省时、术后恢复快、疗效肯定等优点，有着很好的临床应用前景。%Objective To investigate the measurement , feasibility and clinic effect of hyperthermic intraperitoneal chemotherapy (HIPEC) guided by B ultrasound in the treatment of malignant ascites from peritoneal carcinomatosis. Methods From July 2011 to June 2013, B ultrasound-guided approach was used to perform HIPEC on 36 patients affected by malignant ascites secondary to peritoneal carcinomatosis. Every patient underwent HIPEC for three times , by way of continuous circulatory perfusion into peritoneal cavity with saline at 400 ~ 600 mL/min and intraperitoneal perfusion with 5-FU mitomycin-C and cisplatin for 90 minutes with an inflow temperature of (43 ± 0.2)℃. These patients were followed up for a long term. Results Intraoperative course was uneventful in all cases. Complete clinical regression of ascites and related symptoms was achieved in all the 26 patients, partial regression achieved in 8 patients, and no curative effect achieved in 2 cases. The acquired total clinic effectiveness was 94.44%. No postoperative deaths and complication related to the procedure occurred in this study. The KPS grades of patients rose (P < 0.001), the level of tumor markers decreased, including CA199 (P < 0.001), CEA (P < 0.001), CA125 (P = 0.003). Conclusion HIPEC guided by B ultrasound appears to be a safe, feasible and effective procedure for the treatment of debilitating malignant ascites from unresectable peritoneal carcinomatosis , which would have a clinic good perspective in future.
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