| Objective Radical operation continues to be the main means in the management of gastric and large intestinal carcinomas. Even received radical operation, there is still high recurrence rate in advanced cases. Peritoneal recurrence is the most familiar style of recurrence in gastric cancer. Although recurrence from hematogenous metastasis is the most familiar style of recurrence in large intestinal cancer, there are still several patients who will suffere in peritoneal recurrence. So prevention and treatment of peritoneal recurrence are very important in the treatment of gastric and large intestinal carcinomas. Intraperitoneal hyperthermo-chemo-perfusion (IHCP) has been proven to be effective on prevention of gastric and large intestinal carcinomas. The fourth department of Research Institute of Surgery and the department of general surgery of Daping Hospital manufactured an non-circular perfusion system for IHCP. Animal models of intraperitoneal perfusion were made to evaluate the security of IHCP.Methods Twenty-four New Zealand rabbits were randomly divided into four groups: IHCP group (group A), intraperitoneal hyperthermic perfusion group (group B), intraperitoneal normothermic chemotherapy group (group C) and operation group (group D). Vital signs of the rabbits were observed during the operations. CD4~+ and CD8~+ of peripheral blood were measured at the day before operation and at the second day after operation. Blood routine, liver function and renal function of the rabbits were measured at day one, day three, day five, and day seven postoperatively. All rabbits were killed at the 7th day postoperatively to observe intraperitoneal adherence and livers, kidneys and tissue of stomas were resected for pathologic study. Bursting pressure of the stomas were measured in group A and group D.Results 1. Change of vital signs 1) Arterial pressure: During the perfusion, the arterial pressure rised in group A and B, and reached their peak at time 40 minutes since perfusion (P<0.05, both). The peak were (82.8 ± 4.5)mmHg and (85.8 ± 3.4)mmHgrespectively. There were no significant changes in group C. Compared with each other, there were significant difference between group B and group C (PO.01). 2) Pulse: The pulse beat faster at time 40 min in group A, and reached its peak, which was (199 + 28)/min, at time 60 min (PO.01). The pulse beat faster at time 30 min in group B (PO.01). No significant changes happened in group C. There were no significant difference in the three group. 3) Breath: The breath was more quickly in group A since time 30 min (/*<0.01, all). The same thing happened in group B at time 50 min (PO.01). There were no significant changes in group C. Compared with each other, there were no significant difference in the three groups. 4) Temperature of rectum: There were no significant changes in all groups.2. Changes in blood routine 1) White blood cell (WBC): The count increased after perfusion and reached its peak in day 3 in group A (PO.01). Then it decreased to the level of preoperation in day 5. The count increased in day one in group B (PO.01) and decreased to the normal level in day 3. The count increased in day one in group C (/)<0.01) and decreased significantly in day 7 (PO.01). The count increased in day one and day 3 in group D (PO.05, both). The changes of all groups had no difference. 2) Blood platelet (PLT): The count increased in day one after perfusion in group A (PO.05) and in day 3 in group B (P<0.05), but decreased in day 3 in group C (PO.05). There were no significant changes in group D. Compared with each other, the count increased more in group A (PO.05, all). 3) Erythrocyte (RBC), ferrohemoglobin (HGB), and haematocrit (HCT): The values of RBC and HGB decreased postoperatively in group A and became minimum in day 7 (PO.01, both). The value of HCT in group A decreased in day 7 (PO.05). The value of RBC, HGB and HCT decreased variously after perfusion in group B. The value of RBC and HGB decreased in day 1 in group C (PO.01) and the value of HCT had no significant changes. The value of HGB and HCT decreased in day 3 and day 5 in group D while the value of RBC had no significant changes. Compared with each other, there were significant difference in RBC between group A and C, group A and D, group B and D (PO.05, PO.01 and PO.05, respectively). There were significant difference in HGB between group C and group D (PO.05).3. Changes in hepatic function and renal function 1) Albumin (Al): The value decreased in day 5 (PO.05) and reached its valley, which was (15.92±2.33) g/L, in day 7 (PO.01) in group A. It decreased in day 5 (PO.05), and then recovered in day 7 in group B.It decreased in day 5 and day 7 in group C (PO.01 and PO.05, respectively). It decreasedin day 3 and day 5 (PO.05, both) and reached its valley in day 7 (PO.01) in group D.Compared with each other, there were significant difference between group A and B(PO.05), group A and D (PO.01), group C and D (PO.05). 2) Aspartate aminotransferase(AST): It decreased in day 3 and day 7 in group A (PO.05, both). It decreased from day 3in group B. It decreased in day 3 in group C (P <0.01). There were no significant changes ingroup D. The changes of all groups had no significant difference. 3) Alanineaminotransferase (ALT): It decreased in day 3 (PO.05) and reached its valley in day 7(P<0.01) in group A. It decreased in day 5 and day 7 in group B (P<0.01 both). There wereno significant changes in group C. It decreased in day 7 in group D (P<0.05). The changesof all groups had no significant difference. 4) Blood urea nitrogen (BUN): There were nosignificant changes in group A. It increased in day 1 (PO.01), which was (6.53±1.17)mmol/L, and then recovered in day 3 in group B. It increased in day 5 (P<0.01) in group C,which was (7.15±1.70) mmol/L. It decreased in day 7 (PO.05) in group D. Compared witheach other, there were significant difference between group C and the other groups (P<0.05,all). 5) Creatinine (Cr): It increased in day 5 (PO.01), which was (96.83±10.82) mmol/L,and then recovered in day 7 in group A. There were no significant changes in group B andD. It increased in day 3, day 5 and day 7 (PO.05, all) in group C. Compared with eachother, there were no significant difference.4. Changes in subsets of T lymphocyte There were no significant changes with CD4+, CD8+ and CD4+/CD8+ in group A and D. CD4+ significantly increased postoperatively (PO.05), and CQ8+ and CD4+/CD8+ had no significant changes in group B. CD4+ significantly decreased postoperatively (PO.05), and CD8+ and CD4+/CD8+ had no significant changes in group C.5. Bursting pressure of stomas There were no significant difference of the bursting pressure of stomas between group A and D.6. Pathology and histology changes Mild adhesions were found around stomas in each groups. There were no evident adhesions in abdominal cavity. But it was more serious in group D, because there were more bigger area of adhesions and more cords of adhesions. There were no distinctive pathology changes in livers and kidneys. The healing of stomas were normal in each group.Conclusion1. During IHCP, the value of arterial pressure, pulse and breath will increase, but it will not lead to serious outcome. And it has no obvious effect on body temperature.2. IHCP may result in anemia, but will not lead to serious bone marrow depression.3. IHCP may do harm to renal function, but the harm is limited and will recover soon. The reason of renal function damage may be relative to chemical drugs.4. IHCP will not lead to serious damage of liver function. But the decrease of albumin should be paid more attention.5. IHCP has no serious negative effect on immunological function.6. IHCP will not result in serious abdominal adherence or delay the healing of stoma. In conclusion, IHCP does no significant harm to rabbits. With strictly controlledtemperature and dose of medicine, accurate monitoring of vital signs and regular re-examination of blood routine, liver function and renal function postoperatively and compensation of albumin in time, IHCP is safe and feasible. |
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