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1.5 Is apparatus-technical maintenance intraperitoneal himiogipertermicheskoj perfusions

For the purpose of carrying out VHGP the technical equipments which provide warming, constant circulation of a perfusate are used, and also support constant volume of a solution a cytostatics in an abdominal cavity [65].

Any equipment for carrying out VHGP contains following elements:

- The extracorporal contour consisting from several bridged silikonovyh of drainage tubes in which it is possible to allocate: an entrance segment (for inflow); a target segment (for outflow); the basic part of a tube; some the multipunched catheters on the extremities of tubes;

- termostatirujushchee the device;

- The pump for giving of a perfusate from the tank in an abdominal cavity of the patient;

All listed components make uniform perfused system. Apparatus for carrying out VHGP have activly started to be framed and used in clinical practice since 90th years and since then there was a little commercially accessible models (Tab. 8 [65]).

All listed apparatus are based on use of the roller pump and possess following characteristics:

- Achievement of a target hyperthermia for a short time interval;

- Adjustable rate of giving of a perfusate;

- Simplicity of assemblage of system of highways;

- Maintenance service possibility.

Without dependence from the used apparatus for perfusion there is a uniform basic scheme of performance VHGP [65]. The solution containing a chemotherapeutic preparation, moves in an abdominal cavity on pritochnoj highways by means of the roller pump with rate nearby 1 l/min.

The technical equipments for carrying out intraperitoneal himiogipertermicheskoj perfusions

Table 8

The name

The apparatus

The company The country It is approved

FDA

Sign

The European

Certifications

Belmont

Hypertermia

pump

Belmont

Instrument

Company

THE USA Yes Yes
Cavitherm EFS France No Yes
Exiper Medica S.p. A. Italy No Yes
Gamida Tech Sunchip France No Yes
Performer Rand

Corporation

Italy No Yes
THERMOCHEM -

HT

Thermasolutions Niderlandy/

THE USA

Yes Yes

Outflow of a liquid from an abdominal cavity is carried out through special drainages and also provided with work of the roller pump. Warming of a perfusate to necessary temperature occurs in the heat exchanger as a part of the closed perfused contour. As a rule, before perfusion the solution some times circulates only between the tank and the heat exchanger until the minimum temperature - 43оС will be reached.

After that in a solution the antitumoral preparation is added, and perfusate circulation through an abdominal cavity of the patient begins. The solution temperature in an abdominal cavity of the patient during perfusion is supported at level 41-46оС. As solutions for perfusion it is recommended to use isotonic saline solutions (a normal saline solution, solution Ringera) and solutions Dextrosums [92].

There are two cores of technics of performance vnutibrjushinnoj himiogipertermicheskoj perfusions - opened and closed. However recently there were reports on use half-opened or semiclosed the technician [62, 65]. In case of opened VHGP (a technique "Collosseo") after cytoreductive operation the skin of an abdominal cavity in a cut place is fixed by means of a suture material on the special retractor preliminary lifted on height of 15-20 sm over the patient [114]. From above the abdominal cavity is covered with a plastic bed-sheet. During perfusion the surgeon has possibility manually to mix a solution in an abdominal cavity of the patient. It is considered, that the open technics of performance VHGP provides equally effective influence of a chemotherapeutic preparation and temperature on all anatomic structures of an abdominal cavity.

At the closed technics of performance of perfusion the skin of an abdominal cavity is tightly sewn up after the equipment of catheters for inflow and outflow of a perfusate [52]. As a rule, at the closed perfusion the larger volume of a solution for creation of a perfused contour in comparison with an open technique is required, and also the high pressure in an abdominal cavity that can promote deeper penetration of antitumoral preparations into tissues is framed more.

The admixed technicians of performance VHGP (half-opened or semiclosed) have been developed rather recently and are updatings of an open technique of perfusion. Their occurrence in clinical practice has been caused by aspiration to prevent loss of heat during perfusion and to lower harmful influence of steams tsitostatikov on the personnel of the operational.

Example of half-open technics is technics VHGP described P. Rat et al. (2001 [96]. Authors used lateksnuju catch a cold, which was fixed to edges of a skin of a forward abdominal wall, and then fixed on a retractor skeleton. Then over a retractor, was located metakrilatnyj an integument with an aperture for an arm of the surgeon in the centre which tightly closed an abdominal cavity of the patient.

Each of existing the technician of performance VHGP has the certain advantages and disadvantages (Tab. 9 [65]). For today there are no convincing proofs of that one of techniques is better another on indicators of survival rate of patients and frequencies of postoperative complications.

Table 9

The comparative analysis of different techniques of performance of the intraperitoneal

himiogipertermicheskoj perfusions

The characteristic Technicians VHGP
The opened The closed The admixed

(Half-opened /

Semiclosed)

Preparation and heat distribution on an abdominal cavity More

The uniform

+

The irregular More

The uniform

+

Loss of heat during perfusion It is more It is less + It is less in comparison with opened +
Time before achievement of target temperature of perfusion It is more It is less

+

It is less in comparison with opened +
Immediate contact of the surgeon to a chemotherapeutic preparation (with protection) Yes No

+

Yes
Risk of influence of a chemotherapeutic preparation on the personnel of the operational It is more

+

The minimum

+

It is less in comparison with the opened

+

Risk of thermal damage The minimum

+

It is possible It is minimum

+

Complexity of performance of procedure Low + Low + More difficult, than opened -

The note: + - provides potetsialnye advantages of a technique; - provides potential disadvantages of a technique.

However without dependence from the used technics unresolved questions in operative receptions of carrying out intraperitoneal himiogipertermicheskoj perfusions, such as remain: insufficiently uniform distribution of a perfusate on an abdominal cavity, hit a cytostatics in a hypodermic fatty tissue, owing to pressure rising in an abdominal cavity, and also evaporation a cytostatics during procedure that represents danger to the medical personnel. The scientific substantiation of the decision of the given questions was one of the important problems of the given dissertational research.

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A source: ALEKSEEV Valentine Valerievich. IMPROVEMENT OF THE HYPERTERMAL CHEMIOPERFUSION METHOD IN THE SYSTEM OF COMPLEX TREATMENT OF PATIENTS WITH BERUSHINA CARICOMATOSIS. Thesis for the degree of candidate of medical sciences. St. Petersburg 2015. 2015

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