Hipec (Hyperthermic Intraperitoneal Chemotherapy) ve Postoperatif Hemşirelik Bakımı
Özet
HIPEC (Hipertermik Intraperitoneal Kemoterapi), karın içine yayılmış kanserli dokuların cerrahi olarak temizlenmesinin ardından uygulanan bir kemoterapi yöntemidir. İki aşamadan oluşur: Sitoredüktif cerrahi (SRC) ile tümörlerin çıkarılması ve ardından sıcak kemoterapinin karın boşluğuna verilmesi. HIPEC, 41-43 °C’de, belirli basınç altında 3-4 litre serum fizyolojik içine karıştırılan kemoterapötik ilaçların peritoneal perfüzyonu sağlar. Kullanılan ilaçlar genellikle Mitomisin C, Doksorubisin ve Sisplatin gibi sıcaklık artışı ile etkisi artan ajanlardır. Uygulama, açık, yarı açık ve kapalı tekniklerle gerçekleştirilir. HIPEC, kolorektal, over, mide kanserleri ve psödomiksoma gibi durumlarda kullanılır. Preoperatif değerlendirme, PCI (Peritoneal Karsinomatozis İndeksi) ile yapılır; yüksek skorlar HIPEC’in etkinliğini azaltabilir. Hemşirelik bakımı, preoperatif, intraoperatif ve postoperatif dönemlerde hastanın durumu ve komplikasyonları takip ederek, multidisipliner bir yaklaşım gerektirir. Bu süreçte hastaların enfeksiyon riski, sıvı dengesi ve ağrı yönetimi dikkatle izlenmelidir.
HIPEC (Hyperthermic Intraperitoneal Chemotherapy) is a chemotherapy method applied after surgical removal of cancerous tissues spread in the abdomen. It consists of two stages: removal of tumors with cytoreductive surgery (CRC) followed by administration of warm chemotherapy into the abdominal cavity. HIPEC provides peritoneal perfusion of chemotherapeutic drugs mixed into 3-4 liters of physiological saline under certain pressure at 41-43 °C. The drugs used are generally agents whose effects increase with temperature increase, such as Mitomycin C, Doxorubicin and Cisplatin. Application is carried out with open, semi-open and closed techniques. It is used in conditions such as HIPEC, colorectal, ovarian, stomach cancers and pseudomyxoma. Preoperative evaluation is done by PCI (Peritoneal Carcinomatosis Index); High scores may reduce the effectiveness of HIPEC. Nursing care requires a multidisciplinary approach by monitoring the patient's condition and complications in the preoperative, intraoperative and postoperative periods. During this process, patients' infection risk, fluid balance and pain management should be carefully monitored.
Referanslar
https://www.iskenderunses.net/haber/hipec-antakyada-ilk-kez-uygulandi-8682.html
Sticca, R. P., & Dach, B. W. (2003). Rationale for hyperthermia with intraoperative intraperitoneal chemotherapy agents. Surgical Oncology Clinics of North America, 12(3), 689–701.
Ünal, A. E., Güner, M., & Morkavuk, Ş. B. (2017). Peritonektomi ve sitoredüktif cerrahi teknik detaylar ve HİPEK endikasyonları. Türkiye Klinikleri Genel Cerrahi Özel Sayı, 10(2), 81–91.
Drozdogan. (n.d.). Tekrarlayan yumurtalık over kanserinde sıcak kemoterapi – Hipertermik kemoterapi ile birlikte ameliyat. Retrieved August 22, 2024, from https://www.drozdogan.com/images/news/Tekrarlayan-yumurtalik-over-kanserinde-sicak-kemoterapi-hipertermik-kemoterapi-ile-birlikte-ameliyat-237207-966-544.webp
Armedatip. (n.d.). Sıcak kemoterapi – Hipertermik kemoterapi. Retrieved August 22, 2024, from http://www.armedatip.com/uploads/Urunler/thumbs/sicak-kemoterapi-%E2%80%93-hipertermik-kemoterapi_1616480922.jpg
Vining, C. C., Izquierdo, F., Eng, O. S., & others. (2020). Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Technical considerations and the learning curve. Journal of Surgical Oncology, 122(1), 85–95. https://doi.org/10.1002/jso.25939
Strijker, D., Meijerink, W. J. H. J., Bremers, A. J. A., & others. (2021). Prehabilitation to improve postoperative outcomes in patients with peritoneal carcinomatosis undergoing hyperthermic intraperitoneal chemotherapy (HIPEC): A scoping review. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2021.10.006
Raspé, C., Flöther, L., Schneider, R., & others. (2017). Best practice for perioperative management of patients with cytoreductive surgery and HIPEC. European Journal of Surgical Oncology, 43(6), 1013–1027. https://doi.org/10.1016/j.ejso.2016.09.008
Adachi, T., Shinomura, T., & Nomura, R. (2003). Duration of vecuronium induced neuromuscular blockade is shortened during hyperthermic intraoperative intraperitoneal chemotherapy. British Journal of Anaesthesia, 91, 160-161.
Referanslar
https://www.iskenderunses.net/haber/hipec-antakyada-ilk-kez-uygulandi-8682.html
Sticca, R. P., & Dach, B. W. (2003). Rationale for hyperthermia with intraoperative intraperitoneal chemotherapy agents. Surgical Oncology Clinics of North America, 12(3), 689–701.
Ünal, A. E., Güner, M., & Morkavuk, Ş. B. (2017). Peritonektomi ve sitoredüktif cerrahi teknik detaylar ve HİPEK endikasyonları. Türkiye Klinikleri Genel Cerrahi Özel Sayı, 10(2), 81–91.
Drozdogan. (n.d.). Tekrarlayan yumurtalık over kanserinde sıcak kemoterapi – Hipertermik kemoterapi ile birlikte ameliyat. Retrieved August 22, 2024, from https://www.drozdogan.com/images/news/Tekrarlayan-yumurtalik-over-kanserinde-sicak-kemoterapi-hipertermik-kemoterapi-ile-birlikte-ameliyat-237207-966-544.webp
Armedatip. (n.d.). Sıcak kemoterapi – Hipertermik kemoterapi. Retrieved August 22, 2024, from http://www.armedatip.com/uploads/Urunler/thumbs/sicak-kemoterapi-%E2%80%93-hipertermik-kemoterapi_1616480922.jpg
Vining, C. C., Izquierdo, F., Eng, O. S., & others. (2020). Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Technical considerations and the learning curve. Journal of Surgical Oncology, 122(1), 85–95. https://doi.org/10.1002/jso.25939
Strijker, D., Meijerink, W. J. H. J., Bremers, A. J. A., & others. (2021). Prehabilitation to improve postoperative outcomes in patients with peritoneal carcinomatosis undergoing hyperthermic intraperitoneal chemotherapy (HIPEC): A scoping review. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2021.10.006
Raspé, C., Flöther, L., Schneider, R., & others. (2017). Best practice for perioperative management of patients with cytoreductive surgery and HIPEC. European Journal of Surgical Oncology, 43(6), 1013–1027. https://doi.org/10.1016/j.ejso.2016.09.008
Adachi, T., Shinomura, T., & Nomura, R. (2003). Duration of vecuronium induced neuromuscular blockade is shortened during hyperthermic intraoperative intraperitoneal chemotherapy. British Journal of Anaesthesia, 91, 160-161.
