Optimal protocol of normo- and hyperthermal intraperitoneal chemotherapy (ict) in complex management of the widespread endometriosis (iii-iv stages)

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At a hyperthermal variant it is better to begin the intraperitoneal chemotherapy (ICT) right after performance of a surgical stage. Perfusion is better to carry out by introduction through troacar ports of 2 laparoscopic irrigation tips connected to perftision system. It՚s need to provide a horizontal position of the patient, so that the pelvis would be covered with perfusing fluid. An irrigation tip leaves in Douglas pouch, aspirational - collects perfusate from utero-vesical pouch. Perfusion speed is not less than 500 ml/mines, perfusing temperature on input - 42C, duration of perfusion - 30 minutes. The total perfusate amount is 2000-3000 ml in which the demanded doze of cytostatics is contained. There could be a fractional injection of 1000 ml of warm (42C) perfusate intraabdominally and its replacement each 3-4 minutes with new portion of warm solution - duration has to be increased up to 40 minutes, we leave drainage for removal of the rests of perfusate.

At normothermal variant - after performance of a surgical stage we place in an abdominal cavity 1000 ml of the saline containing cytostatics dose. In douglas pouch we leave a drainage not less than 7 mm in diameter which was opened later with 20-24 hours after the primary surgery for removal of the rests of perfusing fluid. Calculation of cytostatics dose is conducted depending on the area of body surface - recommended dose is 60 mg/m² of doxorubicine and 50 mg/m² of cisplatin.

Efficiency of therapy is based on following factors: 1. Direct damaging action of cytostatics doxorubicine and cisplatin on endometrial deposits with activation of the subsequent infiltrates resorbtion. 2. Creation of effective cytostatics concentrations at increasing of perfusate temperature up to 42-45 C on depth up to 5 mm under peritoneum in 30-minutes exposition or at normothermic hydroperitoneum within 20-24 hours after a surgical stage; 3. An opportunity of organ-saving surgery performance in management of uni- and bilateral endometriomas (cysts marsupialization with their subsequent internal layer exposition to cytostatics), and also at retrocervical infiltrative endometriosis; 4. Absence of provocation of development of postoperative adhesive proc.

作者简介

N. Ruhliada

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Email: info@eco-vector.com
俄罗斯联邦, St.-Petersburg, Russia

А. Belyaev

Email: info@eco-vector.com
俄罗斯联邦, St.-Petersburg, Russia

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