1.1 Inclusion and exclusion criteria
Inclusion criteria: (1) 16 ≤ age ≤ 85 years (2) CT, MRI, exploratory laparotomy and/or intraperitoneal free cancer cells confirmed diffuse intraperitoneal implantation metastasis of tumor;(3)Ultrasonography confirmed the abdominal volume of > 3 000 mL.
Exclusion criteria: (1)No malignant ascites or abdominal volume < 1500 mL;(2)Extensive adhesion in the abdominal cavity;(3) Inclusional peritoneal effusion;(4)Total intestinal obstruction;(5) Severe coagulation dysfunction;(6)Too old and obviously poor physical function.
1.2 General case information
The 80 patients admitted to our hospital from June 2017 to June 2019 were divided into an observation group and control group according to different treatment methods. Among the 45 patients in the observation group, 25 were male
and 20 were female. The mean age was 57.87 ± 9.733 years. Mean abdominal volume was 4353.3 ± 685.180 ml; There were 8 cases of primary appendiceal, 12 cases of primary gastric cancer, 20 cases of colon cancer, 2 cases of mesothelioma and 3 cases of ovarian cancer. Among the 35 patients in the control group, there were 18 males and 17 females. The mean age was 58.0 ± 8.570 years. The mean abdominal volume was 4170.0 ± 646.55 ml. There were 6cases of primary appendiceal, 10 cases of primary gastric cancer, 18 cases of colon cancer, none of mesothelioma and 1 case of ovarian cancer. There were no statistically significant differences in gender, age, abdominal volume, and primary disease between the two groups (P > 0.05). (Table 1).
Characteristic
|
Observation group
|
Control group
|
P value
|
gender
|
|
|
|
Male
|
25
|
18
|
0.822
|
female
|
20
|
17
|
Age (years)
|
57.87±9.733
|
58.0±8.570
|
0.760
|
Ascites volume(ml)
|
4353.3±685.180
|
4170.0±646.55
|
0.960
|
Type of primary disease
|
|
|
|
Appendiceal
|
8
|
6
|
0.670
|
Colorectal
|
20
|
18
|
Gastric
|
12
|
10
|
Mesothelioma
|
2
|
0
|
Ovarian
|
3
|
1
|
Table 1 Patient and procedure characteristics
1.3 Methods
In the observation group, 45 patients were first treated with HIPEC for 5 times, followed by 6 ~ 8 courses of intravenous chemotherapy. The intravenous chemotherapy regimen was selected according to the primary disease[5]. The HIPEC drugs for gastric and colon cancer were loplatin, cisplatin, retetrexil and 5-fu, while for ovarian cancer were paclitaxel, loplatin, cisplatin and 5-fu, and the drug dosage was referred to intravenous chemotherapy[6]. Four special HIPEC tubes were placed under laparoscopy to connect to the HIPEC therapeutic apparatus, and chemotherapy drugs were added to 4000 ml normal saline[7]. The perfusion flow rate was 400–600 ml /min, the perfusion time was 60 min, and the treatment temperature was set as 43 ± 0.2℃[7]. Each treatment interval was ≥ 24 hours[8]. The HIPEC therapy instrument used in this treatment was BR-TRG-2 peritoneal thermal perfusion therapy system.
In the control group, 35 patients were treated with intravenous chemotherapy and abdominal puncture pumping. The chemotherapy regimen was selected based on the primary disease, and 6–8 courses of chemotherapy were selected. 1,000 mL of fluid was initially dispensed, and then no more than 500 mL of fluid was removed from the abdominal cavity every day[9]. All patients were evaluated for efficacy one month after the end of treatment, and then followed up every month for six months.
1.4 Efficacy Evaluation Criteria
According to WHO standards, in evaluating the clinical efficacy of patients, the patients were divided into complete remission (CR), partial remission (PR), disease stability (SD), and disease progression (PD). CR: Ascites disappeared for more than 4 weeks; PR: Ascites decreased by more than 50% and lasted more than 4 weeks; SD: No significant ascites, changes in asthma or ascites are less than 50%; PD: Increased ascites[10]. Total effective rate = (CR + PR) / total number of cases × 100%. Adverse reactions were classified into ⅠཞⅣ degrees according to WHO anti-cancer drug adverse reaction scale[11].
1.5 Statistical Analysis
The general clinical data and qualitative data of the treatment results of 80 patients with malignant ascites were processed by SPSS19.0 using χ2 test and quantitative data were processed by t test. P < 0.05, statistical data can be considered statistically significant.