关键词: 结直肠肿瘤, 腹腔热灌注化疗, 灌注治疗曲线, 肠造口术, 安全性

Abstract: Objective  To explore the feasibility and safety of hyperthermic intraperitoneal chemotherapy in patients with colorectal cancer undergoing radical resection followed by enterostomy.Method This study retrospectively analyzed the clinical data of 184 patients with colorectal cancer admitted to Affiliated Union Hospital,Tongji Medical College,Huazhong University of Science & Technology from April 2021 to December 2021,and divided them into three groups: radical resection + hyperthermic intraperitoneal chemotherapy (n=117),radical resection + enterostomy (n=36),and radical resection + enterostomy + hyperthermic intraperitoneal chemotherapy (n=31).Tube patency was evaluated by hyperthermic intraperitoneal chemotherapy curve analysis,and adverse events occurring during treatment observation were graded according to the common terminology criteria for adverse events (CTCAE 5.0) published by the US Department of Public Health.Binary logistic regression was used to analyze the independent risk factors affecting the patency of hyperthermic intraperitoneal chemotherapy tube,and χ2 test and Fisher’s exact test were used to analyze the effect of hyperthermic intraperitoneal chemotherapy on the occurrence of perioperative adverse events in colorectal cancer patients who underwent enterostomy after radical resection.Results A total of 255 times of hyperthermic intraperitoneal chemotherapy were completed in 148 patients who underwent hyperthermic intraperitoneal chemotherapy after radical resection,of which 125 times (49.0%) had smooth perfusion process,84 times (32.9%) had smooth perfusion process after adjustment,and 46 times (18.0%) had unsmooth perfusion process.The results of binary logistic regression analysis indicated that enterostomy was an independent risk factor for incomplete patency events and complete occlusion events in colorectal cancer patients who underwent hyperthermic intraperitoneal chemotherapy after radical resection (P＜0.05 for all).Of the 67 patients with colorectal cancer who underwent radical resection followed by enterostomy,a total of 35 (52.2%) had perioperative adverse events of varying degrees,including 29 patients with grade 2 adverse events,6 patients with grade 3 adverse events,no patients with perioperative grade 4 adverse events,and no perioperative deaths.There was no significant difference in the incidence rate of perioperative adverse events between colorectal cancer patients who underwent enterostomy after radical resection without hyperthermic intraperitoneal chemotherapy and those who underwent enterostomy after radical resection and hyperthermic intraperitoneal chemotherapy (P>0.05).Conclusion Occlusion events are common in patients with colorectal cancer who undergo hyperthermic intraperitoneal chemotherapy after radical resection.For colorectal cancer patients undergoing intraperitoneal hyperthermic perfusion chemotherapy after radical resection,enterostomy significantly increases the risk of incomplete patency events and complete occlusion events,increasing the difficulty of operation,but it is still safe and feasible.

Key words: colorectal neoplasms, hyperthermic intraperitoneal chemotherapy, perfusion therapy curve, enterostomy, safety