HYPERTHERMIC INTRAOPERATIVE INTRAPERITONEAL CHEMOTHERAPY METHOD FOR TREATING THE CASES OF GENERALIZED MALIGNANT RECTAL NEOPLASMS

摘要

FIELD: medicine.;SUBSTANCE: method involves carrying out radical surgical intervention. Abdominal cavity lavage is carried out using lavage solutions during 15-20 min after having accomplished all surgical intervention stages. The lavage solution is removed from abdominal cavity. Draining silicon tubes are set into the right subdiaphragmal space, into the right subhepatic space and into the right lateral canal, into the left subdiaphragmal space, into the right lateral canal and into small pelvis. Abdominal reservoir is formed by suspending laparotomic wound edges by means of Seagal retractor. Polyethylene film having cruciform cut in its center is fixed on laparotomic wound edges. The abdominal reservoir is filled with isotonic solution on sodium chloride bases or on dialysis solution base or on Ringer-Lock solution base as perfusate. The solution contains primary and additional chemopreparations. Perfusion solution has Cysplatin or Platinol or Carboplatin at a dose of 50 mg/m² of patient skin area or Mytomicin C at a dose of 20 mg/m² of patient skin area as the primary preparation and 5-Fluorouracyl as the additional preparation at a dose of 1 mg/m² of patient skin area. The perfusion solution is introduced via draining tubes at 44-46°C into upper regions of the abdominal cavity. The solution is evacuated from it at a temperature not lower than 42.5°C via draining tubes arranged in pelvic cavity and iliac regions. Perfusion solution chemopreparations temperature control is carried out by means of heat sensor transducers mounted in draining tubes. Chemotherapy is carried out with closed perfusion solution chemopreparations circulation during 60-120 min in abdominal cavity at a rate of 500-2000 ml/min concurrently manually mixing the chemopreparation solution. The abdominal cavity is tightly sutured after having applied the hyperthermic intraoperative intraperitoneal chemotherapy. Intraperitoneal chemotherapy is carried out in postoperative period daily from the first to the fifth day after the operation. To do it, chemotherapy preparation based on physiologic sodium chloride solution or on dialysis solution or on Ringer-Lock solution, containing 5-Fluorouracyl at a dose of 1 mg/m² of patient skin area is introduced via retained draining tubes with its exposure time being equal to 8-12 h. Then the draining tubes are removed.;EFFECT: enhanced effectiveness of treatment; prevented abdominal cavity and small pelvis region from being inseminated; prolonged survival period; improved life quality.;9 cl