CAJ | 학술논문

背景肿瘤细胞减灭术联合腹腔内热灌注化疗(cytoreductive surgery with hyperthermic intraperitoneal chemotherapy,CRS-HIPEC)用于治疗腹膜表面恶性肿瘤(peritoneal surface malignancies,PSM)正发挥越来越重要的作用,其临床应用日渐广泛.目的综述通过研究CRS-HIPEC的病理生理改变,旨在为临床麻醉医生围麻醉期处理提供参考.内容 CRS-HIPEC手术操作复杂且时间冗长,切口巨大,伴随大量液体丢失,尤其是HIPEC阶段,可导致高血流动力学状态、体温升高、凝血功能下降、腹膜血管通透性增加,化疗药致心律失常和肾脏毒性,肌松药时效缩短等一系列病理生理改变,其围术期管理复杂.因此,有必要采用脉搏指示剂连续心输出量监测(pulse-indicator continuous cardiac output,PiCCO)等监测手段以优化围术期治疗.趋向随着手术技术和麻醉处理的进步,CRS-HIPEC患者的预后有望进一步改善.
배경 종류세포감멸술연합복강내열관주화료(cytoreductive surgery with hyperthermic intraperitoneal chemotherapy,CRS-HIPEC)용우치료복막표면악성종류(peritoneal surface malignancies,PSM)정발휘월래월중요적작용,기림상응용일점엄범.목적 종술통과연구CRS-HIPEC적병리생리개변,지재위림상마취의생위마취기처리제공삼고.내용 CRS-HIPEC수술조작복잡차시간용장,절구거대,반수대량액체주실,우기시HIPEC계단,가도치고혈류동역학상태、체온승고、응혈공능하강、복막혈관통투성증가,화료약치심률실상화신장독성,기송약시효축단등일계렬병리생리개변,기위술기관리복잡.인차,유필요채용맥박지시제련속심수출량감측(pulse-indicator continuous cardiac output,PiCCO)등감측수단이우화위술기치료.추향 수착수술기술화마취처리적진보,CRS-HIPEC환자적예후유망진일보개선.
Background Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS-HIPEC)is playing an increasing role in the therapeutic management of patients with peritoneal surface malignancies,being applied with increasing frequency.Objective This review is aimed to provide anesthesiologists with clinic reference about periaenesthetic management by summarizing the physiopathological changes during CRS-HIPEC.Content CRS-HIPEC is a quite complicated and time-consuming process,with giant abdominal incision,huge fluid loss.The HIPEC phase,characterized by significant physiopathological changes including high hemodynamic status,increased temperature,abnormal blood coagulation,increased peritoneal vascular permeability,arthythmia and kidney toxicity induced by chemotherapeutic agents,quicker recovery from muscle relaxants and so on,particularly deserves refined perioperative management.Therefore,it is necessary to adopt advanced monitoring methods like PiCCO etc to optimize the therapeutic measures.Trend Due to improved surgical technique and anesthetic management,CRS-HIPEC,an aggressive procedure can be performed with a better prognosis providing a strong interaction between the surgeon and his partner anesthesiologist is warranted.