OBJECTIVE: To investigate the early complications and preventive and curative measures of subcutaneously implanted chemotherapy pumps in combined abdominal chemotherapy. METHODS: Fifty-seven cases of intermediate to advanced gastrointestinal tumors with intraoperative chemotherapy pump implantation from May 2003 to May 2006 were followed up and summarized the complications and preventive and curative measures in the recent period and during chemotherapy. Results: There were 10 cases of complications related to chemotherapy pump, with an incidence of 17.5%, including 5 cases of blockage of chemotherapy pump, 3 cases of subcutaneous hematoma, 1 case of poor fixation of chemotherapy pump body, and 1 case of local tissue erythema, degeneration and necrosis due to drug extravasation. CONCLUSION: The early complication rate of chemotherapy pump implantation is low, and its complications are preventable. In the treatment of abdominal cancer, chemotherapy is usually given after surgical resection of the cancer to kill the residual cancer cells. Because the blood and lymphatic circulation pathways are cut off and destroyed during surgery, the concentration of drugs applied through intravenous chemotherapy drugs to reach the resected stump of the cancer after surgery is very low, which to a certain extent reduces the efficacy of chemotherapy drugs on the metastasis of the abdominal implantation of the cancer. In contrast, infusion chemotherapy via chemotherapy pump in the tumor area can allow anti-cancer drugs to enter the tumor tissues selectively, in high concentration and in large doses, thus improving the anti-cancer efficacy and reducing the systemic toxic side effects. The peritoneal chemotherapy via subcutaneous buried chemotherapy pump has been widely used in the chemotherapy of middle and late stage tumors and the prevention of recurrence after surgical resection of tumors. In our hospital, from May 2003 to May 2006, 57 patients with progressive gastrointestinal tumor were treated with peritoneal chemotherapy via subcutaneous buried chemotherapy pump to prevent and treat abdominal metastasis with good efficacy, and the chemotherapy pump was generally started in two weeks after surgery, and the early complications and prevention are summarized as follows: I. Clinical data (1) Placement of pump and chemotherapy method: About 3 cm above the umbilicus between the anterior sheath of the rectus abdominis muscle and the subcutaneous fat layer. Separate the tunnel and bury the chemotherapy pump into this gap at about 8 cm from the incision and fix it on the tendon membrane with intermittent sutures, as the tissue is loose at this level and there are few blood vessels, often without special hemostasis. The catheter was placed in the residual of the lesion resection. Cisplatin was also given for intraperitoneal chemotherapy. The skin was disinfected with iodophor, the syringe was inserted vertically until there was resistance, the drug was injected slowly, and heparin solution was given before and after chemotherapy. Chemotherapy was administered at 2 weeks and 2-6 months after surgery, respectively, for 5 days each time, for a total of 6 courses of treatment. (2) Complications and treatment methods: From May 2003 to May 2006, there were 57 patients with progressive gastrointestinal tumors treated with peritoneal chemotherapy via subcutaneous buried chemotherapy pump, 42 men and 15 women with an average age of 56 years. Among them, there were 5 cases of blockage of chemotherapy pump, 1 case of blockage without use after operation and 4 cases of blockage within 6 months after use, all of them were successfully injected with heparin solution after flushing; 3 cases of subcutaneous hematoma were found on the 3rd day after operation when changing medicine, 2 of them were subcutaneous petechiae, which subsided after a week of external application of dermatitol, and the other case was a large petechiae within the peeled subcutaneous space, which was applied with iodine gauze and pressure bandage, and most of the hematoma was absorbed after 3 days; the body of chemotherapy pump was poorly fixed in 1 case. One case of poorly fixed chemotherapy pump body, which was obviously tilted, was successfully injected with drugs after manual repositioning; one case of local tissue redness, degeneration and necrosis caused by drug extravasation, which was significantly improved by closed and wet dressing treatment, but the patient died of tumor recurrence and metastasis before complete improvement. In this group, there were no complications such as flip of chemotherapy pump body, local infection or blood accumulation, drug extravasation due to broken and fractured catheter, and intestinal leakage due to long-term drug drip. II. Discussion: The positive rate of peritoneal free cancer cells (FCC) in progressive gastrointestinal tumors is 20%~80% [3-4]. Postoperative patients often present with various types of recurrences and metastases. Postoperative peritoneal recurrence accounts for 42.5%-61.5% and local recurrence accounts for 16.7-41.7% [5], and free cancer cells in the peritoneal cavity are a prerequisite for the formation of peritoneal metastases [6]. Studies have shown that the pharmacokinetic advantage of intraperitoneal administration to prevent and treat regional lymph node, liver and peritoneal recurrence of GI tumors [7] has better efficacy in malignant ascites and has a greater improvement in patient survival and quality of life [8]. It has been reported that early high-dose and high-volume intraperitoneal chemotherapy can fully and evenly distribute the drugs in the peritoneal cavity, which can make the drugs absorbed through the peritoneum and kill the “planted” cancer cells, and make the drugs circulate into the liver through the portal vein system, providing high concentrations of anti-cancer drugs to the portal vein and liver, which is beneficial to prevent liver metastasis [9], which in turn strengthens the effect of intravenous chemotherapy. This enhances the effect of intravenous chemotherapy. It has the following advantages [10]: (1) it can be used repeatedly in large doses for a long time, with high local drug concentration and reduced side effects; (2) the drug concentration in the cavity is increased, and the drug is absorbed into the portal vein through the peritoneum and abdominal organs, so that the drug concentration in the liver is increased and long-lasting, which can reduce the occurrence of liver metastasis; (3) the drug is absorbed into the body circulation in the abdominal cavity; (4) the method is simple and safe and economic. The accurate selection of tumor target area for pump implantation during surgery is to establish a chemotherapy “highway” from the body surface to the tumor area, and the repeated infusion of chemotherapy drugs into the pump after surgery can make the drug concentration in cancer tissue and paracancerous lymphatic tissue 19 and 23 times higher than that in systemic chemotherapy, and the effective effect time is long. Chemotherapy pump implantation is not complicated, however, the following complications may occur: (1) blockage of chemotherapy pump due to tube obstruction. The preventive measures are: check the patency of the catheter and chemotherapy pump body during the operation; flush the pump with a saline to heparin solution of 100ml:12500U at regular intervals (half a month to one month) after the operation. (2) Drug extravasation, local tissue deformation, necrosis The preventive measures are: use a special needle or No. 5 scalp needle; ensure that all needles are pierced into the drug pump cavity; inject slowly and uniformly, can use micro-syringe pump; when encountering chemotherapy pump blockage, can not blindly pressure injection; such as drug extravasation of local redness and swelling, the use of chemotherapy pump body around the fluid back, procaine closure (can be added with dexamethasone 5mg), ethanol wet compress and other treatments. 0.2%~0.5% procaine solution local closure has three effects: ① has a protective effect on the nervous system, blocking the transmission of malignant stimuli; ② dilate blood vessels, improve blood circulation, promote metabolism; ③ itching and pain relief. Therefore, the effect on the sterile inflammation caused by chemotherapy drug extravasation is obvious, the earlier the local closure, the better the effect, usually closed once, if necessary, can be closed several times until the symptoms improve significantly. (3) chemotherapy pump body is fixed poorly The preventive measures are: the same spacing fixed 3 points during surgery, to ensure that the chemotherapy pump body in a plane. (4) Chemotherapy pump body compression of the skin leading to skin necrosis Its preventive measures are: intraoperative placement of chemotherapy pump to have a thin layer of fatty tissue between the skin and chemotherapy pump body, about 0.3~0.5cm. (5) Local infection, accumulation of blood or fluid Its preventive measures are: intraoperative strict aseptic technique, hemostasis should be complete. (6) Catheter breakage and fracture leading to drug leakage The preventive measures are: intraoperative inspection of the catheter for breakage, fracture, leakage, etc. (7) Intestinal perforation due to compression of intestinal wall by chemotherapy pump catheter or penetration of intestinal wall by long-term drug injection Its preventive measures are: intraoperative placement of chemotherapy pump with a certain distance between catheter and intestine; appropriate change of body position during drug injection. In summary, the early complication rate of chemotherapy pump implantation is low, and its early complications are mostly related to surgical operation, which can be prevented and treated. However, complications caused by implantable chemotherapy pumps should be taken seriously, and corresponding prevention and treatment strategies should be adopted for different complications.