Take 1 sterile No.8 infant catheter, and place one side of the catheter on the wound surface of tumor bed (for ileocecum or ascending colon tumor, place the catheter in the paracolonic groove at the lower right of the liver; If there is a tumor in the splenic flexure of colon or descending colon, put the catheter into the left paracolic sulcus to reach the lower splenic pole; If it is a sigmoid colon or rectal tumor, put the catheter into the pelvic cavity), the other end of the catheter leads out of the abdominal cavity and dives into the muscle layer of the abdominal wall for about 5 cm, then leads out of the catheter through the small hole of the abdominal wall and is fixed on the abdominal wall with silk thread. 500mg 5-Fu 5-Fu and 100 mg of carboplatin were dissolved in 500 ml of 0.9% sodium chloride solution and quickly injected into abdominal cavity for 5 days. Repeat 1 course every month, ***6 courses. When the weather is cold, it is advisable to preheat the liquid to about 37℃ in order to avoid the stimulation of cold liquid to the abdominal cavity. No other anti-tumor drugs or methods were used during intraperitoneal chemotherapy. Adverse reactions occurred during chemotherapy, and symptomatic support treatment was carried out when necessary. Blood routine and GPT were checked before and after chemotherapy, and liver B-ultrasound and serum carcinoembryonic antigen 1 time were rechecked every month, which was convenient for tumor follow-up observation and curative effect evaluation.

nurse

First, the efficacy of intraperitoneal chemotherapy: intraperitoneal chemotherapy has the characteristics of high selective regional chemotherapy pharmacokinetics, which can continuously maintain a high concentration of anticancer drugs in peritoneal fluid, portal vein blood, peritoneal lymphatic system and liver, so that free cancer cells or residual tiny cancer foci in abdominal cavity and common recurrence and metastasis sites are soaked in high concentration of anticancer drugs and directly attacked by anticancer drugs. Speyer et al. found that several hours after intraperitoneal injection, the concentration of anticancer drugs in abdominal cavity was 400 times higher than that in plasma. Derick et al. found that intraperitoneal administration could make the concentration of 5-Fu on abdominal cavity surface 300 ~ 2 200 times higher than that in blood. The most common recurrence sites after colorectal cancer surgery are the primary focus and its lymph nodes, and the most common spread sites are the liver and abdominal cavity. Therefore, local intraperitoneal chemotherapy is an important means to control postoperative recurrence and metastasis.

Second, the adverse reactions of intraperitoneal chemotherapy: after intraperitoneal injection of anticancer drugs, most of the drugs enter the liver through portal vein circulation after absorption, and enter the systemic circulation after liver metabolism and detoxification. A small amount of drugs are cleared through peritoneum, and drugs are absorbed through peritoneum and directly enter the systemic circulation, but the clearance of peritoneum only accounts for 65,438+0/65,438+00 of the total clearance. Because the concentration of drugs in abdominal cavity is much higher than that in other parts of the body, the adverse reactions caused by chemotherapy drugs are much lighter than those caused by systemic chemotherapy. In the 32 cases of postoperative intraperitoneal chemotherapy we observed, no 1 case had complications such as chemical peritonitis, intestinal adhesion, intestinal obstruction and intestinal paralysis. In the last few days of the course of treatment, 25 patients developed digestive tract symptoms of different degrees, such as nausea, vomiting, loss of appetite, abdominal distension, dull pain and discomfort, which were tolerated by ordinary patients. The inhibitory effect of chemotherapy drugs on bone marrow varies from person to person. Generally, white blood cells in peripheral blood are in the normal range. Only 1 patients' white blood cells decreased to 2.0× 109/L after two courses of treatment, while after 1 month of symptomatic support treatment, the peripheral white blood cells increased to 4.5× 109/L, and the next one continued. 32 patients did not die during intraperitoneal chemotherapy.

Nursing care of intraperitoneal chemotherapy: blockage of chemotherapy tube: catheter blockage occurred, accounting for 75%. On the one hand, the reason may be that the tissue around the omentum or intestine partially wraps the abdominal end of the catheter. At this time, the pressure in the tube can increase obviously when injecting drugs, and it is difficult to inject drugs or the liquid medicine flows out of the abdominal tunnel after injecting from the tube. In view of this situation, the tunnel mouth should be pressed hard before each drug injection, and then the pressure should be quickly increased, and the liquid medicine should be injected with a 50 ml syringe. Once the liquid medicine breaks through the package, both the patient and the nurse who injected the medicine have a clear sense of breakthrough, and then the drug injection is very smooth. On the other hand, the catheter is blocked due to exfoliated cells and fibrin coagulation in the abdominal cavity, which only appears at the lateral end of the catheter. The naked eye can see that there are yellow and white crystals in the catheter, and the liquid medicine can't be injected at all. At this time, the tube wall can be lightly pressed, and the crystal will be pulverized after being broken, and then it will be reversely ejected from the catheter cavity; You can also inject a small amount of physiological saline first, wait for the crystal to dissolve in water and expand into a soft embolus, then extrude the embolus in reverse, and then inject drugs. Through the above nursing measures, patients can successfully complete intraperitoneal chemotherapy.

In order to obtain the cooperation of patients and their families, in addition to routine nursing, psychological nursing was carried out according to the psychological characteristics of patients in different periods, and a harmonious and reliable doctor-patient relationship and nurse-patient relationship were established. Tell patients and their families the advantages and possible complications of intraperitoneal chemotherapy, and the similarities and differences between local intraperitoneal chemotherapy and systemic chemotherapy. In particular, it is necessary to explain the nursing methods of abdominal wall catheterization to patients and their families, so that they can correctly handle the discomfort such as granulation hyperplasia, swelling of abdominal wall tunnel mouth, and the way of placing chemotherapy tubes outside the abdominal wall. This will not affect the normal life of patients, but also can be treated smoothly and achieve satisfactory treatment results.