Abercrombie France,Postoperative complications of

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Postoperative complications of intraperitoneal chemotherapy for colorectal cancer and its prevention

Key words Intraperitoneal chemotherapy
Intraperitoneal chemotherapy (intraperitoneal chemotherapy, IPC) is an important measure of regional chemotherapy, regional chemotherapy with high selectivity characteristics, are already widely used in adjuvant treatment of colorectal cancer in clinical application there are some complications, this paper issues related complications and their prevention are reviewed.
1 drug delivery-related complications
1.1 infections caused by catheters abdominal infection and abdominal infections, including infections, its incidence is closely associated with the catheter. Long-term intraperitoneal chemotherapy catheter and two single-puncture method, reported in the literature [1], prone to long-term indwelling catheter infection, intestinal perforation, complications up to 67%, only 58% of patients can adhere to the completion of chemotherapy treatment, a single puncture of the concurrent Only 19% of patients. At home and abroad [2] are mostly one-time use of intra-abdominal puncture method: abdominal venipuncture catheter needle and after silicone tube insertion, intraperitoneal chemotherapy, treatment after extubation reduces the incidence of infection. Studies have shown that [3]: Prophylactic catheter broad-spectrum antibiotics during the catheters to prevent local infection may arise, to avoid anastomotic catheter placement to avoid the occurrence of retrograde infection. Infection during chemotherapy should be timely removal of catheters, with the use of broad-spectrum antibiotics and intravenous nutritional support, if necessary, surgical treatment.
1.2 catheter obstruction, shedding [3,[link widoczny dla zalogowanych],4] The main causes of catheter obstruction infusion of high concentration, viscous liquid, not in a timely manner or red tube red tube is not completely sealed tube method incorrect. To maintain catheter patency, should replace the first infusion, heparin cap. Second, we must promptly red tube, grasp the correct red tube, sealed tube method. Note red tube pressure and speed, the use of saline pressure pulse sealed tube, should continue to push the injection needle back sealing solution to ensure positive pressure within the duct state, to prevent backflow of blood caused by catheter blockage. For patients with catheter obstruction, aspiration can be used thrombolytic therapy with urokinase dilution, must not forcibly injected drugs. Often a result of catheter placement for a long time off and peritoneal exudate led to decline in fixed-paste viscosity, catheter position changes with the slip. No case of peritoneal exudate can be given to replace the fixed-paste, if given more timely replacement of leaking or exposed parts of the catheter and the skin sutured catheter fixed portion shall remain in vitro were fixed, in order to reduce the tension tube. After chemotherapy pump inserted catheter occlusion often due to poor or improper placement of catheter end of the fixed duct ligation thread too tight, or long-term anticoagulation is not caused by injection. Therefore, the depth of catheter placement surgery to fit the fixed catheter should not be too tight ligatures, periodic injection of heparin after dilution as
1.3 local ecchymosis and subcutaneous abdominal bleeding in patients with advanced colorectal cancer, due to chronic malnutrition, anemia and thrombocytopenia, blood coagulation is poor, often puncture the abdomen or subcutaneous ecchymosis bleeding. Catheter should pay attention to the choice of location: the literature [4] in the left lower quadrant and umbilical connections outside the 1 / 3 of the puncture, do not hurt the larger vessels, if the bias in acupuncture, may damage the inferior epigastric artery and vein, if hematoma occurs, needle should be pulled out, local pressure dressing, to be hot at the same time can promote absorption of hematoma.
1.4 extravasation of intraperitoneal chemotherapy drugs if the catheter into the abdominal cavity partially or completely not started to delivery, may cause the liquid injected into the abdominal wall, causing local necrosis and a series of serious adverse consequences. The incidence is about 0.3% to 4.7% [5]. Common treatment methods include:
1.4.1 Non-drug treatment [6]
(1) general treatment of drug extravasation within 48 h, should raise the affected area to promote the local extravasation of drug absorption.
(2) cold reduce the anthracycline anticancer drug, taxol, nitrogen mustard, adriamycin, etc. due to skin lesions. Extravasation of ice cold can break the skin at 24 ~ 48 h, extravasation of anthracycline anti-cancer drugs is disabled after the heat.
(3) hot hot for extravasation of anticancer drugs of plant bases, such as vincristine, vinblastine, vinorelbine, leakage will increase the toxicity of local cold .
1.4.2 drug treatment
(1) hyaluronidase for plant bases, such as vincristine, paclitaxel extravasation. Usage: hyaluronidase diluted with saline dubbed 150 u / ml preparation, repeated subcutaneous injection in the extravasation of 150 ~ 900 u, a few hours after repeated injections [7].
(2) sodium thiosulfate can be used in high concentrations of cisplatin extravasation. Usage: 4 ml 10% sodium thiosulfate mixed with 5 ml water for injection, that is, 0.17 mol / L sodium thiosulfate solution in the area to do multiple subcutaneous extravasation can be repeated dosing [7].
(3) DMSO Bertelli et al [8] conducted a prospective study showed that: DMSO can prevent leaking chemotherapy after multiple ulcers can be used anthracycline, mitomycin, cisplatin, ifosfamide, and fluorouracil and other drugs extravasation. Usage: each 50% to 90% of dimethyl sulfoxide 1.5 ml applied to the leakage of local, every 6 to 8 hours 1,[link widoczny dla zalogowanych], once every 7 ~ 14 d, DMSO let it dry naturally partial, is not available gauze. Dongtong Jun et al [9] study also showed that: 99% topical application of DMSO in the extravasation site every 6 hours 1, once every 14 days, effective up to 100%.
(4) the right Leizuo Health is a safe and effective cardioprotective drugs have been approved in many countries for reducing anthracycline-induced cardiac toxicity, and later study found anthracycline drug for treatment of exudative have a good effect. Langer et al [10] study shows that: the right Leizuo Health leaking for anthracycline-induced ulcers have a good therapeutic effect,[link widoczny dla zalogowanych], reducing the leakage rate of surgical intervention areas.
(5) granulocyte macrophage colony stimulating factor (GMCSF) Nagi et al [11] using GMCSF treatment of doxorubicin extravasation causes a skin ulcer (ulcer about 7 cm × 2 cm) of the patients achieved good results, the GMCSF 300 μg (10 ml, 30 mg / L) was injected into the edge of the ulcer, at first 2 weeks 3 times a week, after 2 weeks 2 times a week granulation tissue after treatment, ulcers, skin ulcer edge epithelial tissue grew well and had Ⅱ, suture, ulcers healed, avoiding skin graft.
1.4.3 Surgical treatment for surgical treatment of the time there is no precise criteria, most foreign scholars [12] recommended conservative treatment first, but if a larger range of drug leakage, the patient occurrence of severe pain or oozing after 1-3 weeks without healing tendency of the lesion, it is necessary debridement, skin grafts and other treatment. MRI examination and fluorescein injection and ultraviolet irradiation can help determine the scope of leakage, to determine extent of surgery.
2 chemotherapy-related complications
2.1 gastrointestinal toxicity
2.1.1 nausea and vomiting are more common chemotherapy drugs can stimulate the release of chromaffin cells in the intestinal wall to the role of 5HT3 5HT3 receptors in the small intestine, activation of medullary vomiting center , causing nausea, vomiting. Yin Kai-sheng et al [13] studies suggest that granisetron chunga metoclopramide and dexamethasone for the prevention and control of combined chemotherapy with cisplatin-induced nausea and vomiting, more effective than granisetron alone (especially in the first chemotherapy 3 to 4 days), and can reduce the amount of granisetron. Money Section Qingdeng [14] clinical studies will be booths and tables along is ondansetron can selectively inhibit the 5HT3 receptor high, with a strong antiemetic effect; but Navoban half-life in blood up to 8 40 h, as ondansetron 2.5 to 13 times a day, you can just use 1. Meanwhile, the diet during chemotherapy is an important aspect of regulation, eating high-calorie, high protein, high vitamin, low-fat soft food, avoid greasy foods can be less nausea and vomiting. Nausea, vomiting, a variety of reasons is also affected by psychological factors, has been reported [15] language suggests cisplatin significantly reduced chemotherapy-induced vomiting.
2.1.2 Liquid abdominal pain and bloating the number and efficacy of chemotherapy to play and is closely related to the incidence of abdominal distension. Foreign scholars [16] that require large-capacity infusion intraperitoneal chemotherapy, usually every 1. 5 ~ 2L is appropriate, either to school advantage, the domestic capacity for more click here. Clinical studies have shown [17]: You can order by changing the administration, heating, etc. can reduce abdominal pain, abdominal distention occurred: ① chemotherapy order: first injection of saline, then perfused with saline + chemotherapy, reducing the drug concentration to reduce the stimulation of peritoneal; ② Infusion should be preceded by heat (37 ~ 42 ℃), generally the first heat plus drug, to prevent adverse drug reactions due to heating caused by the occurrence, when the liquid temperature and body temperature were similar, patients can reduce the discomfort; ③ After local chemotherapy Zhu Huanzhe turn over more activities, knee-chest position, so that chemotherapy drugs and increased intra-abdominal tissue contact area to achieve better therapeutic purposes, and to reduce local irritation.
2.1.3 diarrhea and constipation may occur during chemotherapy, diarrhea, started chemotherapy at the same time protective agent with the intestinal mucosa and convergence Smecta antidiarrheal drugs easily kept stopping, Shenling, Atractylodes Powder, can effectively prevent the occurrence of diarrhea. Often occurs after chemotherapy, alternating diarrhea and constipation phenomenon, and because some patients after chemotherapy, liver damage, so do not apply soap enema [18]. The enema is to soften the stool of a neutral acidic lubricating agents, but also a mild irritant laxative, enema saline enema can be well combined treatment of chemotherapy-induced constipation [19].
2.2 after chemotherapy, bone marrow toxicity was neutropenia usually occurs, especially granulocytes decreased as the dose increased, platelets, red blood cells are affected to various degrees. Reported in the literature [20], thymosin can improve immunity, can significantly reduce the toxic side effects, especially to help prevent bone marrow suppression. Such as white blood cells than normal white blood cell drug with a rising time: shark liver alcohol,[link widoczny dla zalogowanych], oral or leucogen. Granulocyte-macrophage colony-stimulating factor subcutaneously, continuous 7 ~ 10 d, if necessary, to give blood transfusion [18].
2.3 urinary tract toxicity of cyclophosphamide, mitomycin, cisplatin and so there is a certain urinary tract toxicity, leading to oliguria, proteinuria, and tubular urine, re- were caused by toxic cystitis and acute tubular necrosis. Control measures include [21]: 1 d before the start of chemotherapy hydration, daily fluid 3000 ~ 4000 mL, the daily urine output during chemotherapy should be> 2500 mL, intravenous chemotherapy, while sodium thiosulfate antidote to relieve Shun platinum on renal tubular damage, encourage patients to drink more water and given diuretics to reduce the concentration of drug within the bladder, reduce the incidence of cystitis. John H [22] a large number of data shows that amifostine (Amifostine, also known as WR2721) is a broad-spectrum selective cytoprotective agent, prophylactic use can not only reduce the nephrotoxicity of cisplatin, but also can improve cisplatin treatment.
2.4 nervous system toxicity [23] oxaliplatin, the most common adverse reaction, its occurrence rate is almost 100%, expressed as numbness in extremities, needle-like pain, muscle cramps , re-induced laryngeal spasm,[link widoczny dla zalogowanych], life-threatening. The preventive measures include: keep warm, within 3 d after treatment to avoid the cold stimulation, not into the cold, do not brush your teeth with cold water, wash your face. Mild symptoms were gradually ease after by the heat, symptoms and may be appropriate with dexamethasone and aspirin. Medication should be ready before the package placed in patients bedside tracheotomy in order to laryngospasm is not available.