摘要
目的探讨胸腔镜辅助下胸腔内高温灌注化学治疗肺癌恶性胸腔积液的方法和效果。方法1999年2月～2006年3月,我们对70例肺癌恶性胸腔积液患者随机分为治疗组(35例)和对照组(35例)。治疗组在全身麻醉胸腔镜下行胸膜活检术,并用人工心肺机恒温43℃生理盐水3000ml加顺铂300mg灌注1h;对照组予以胸腔引流,胸腔内灌注顺铂60～90mg。比较两组治疗前、后胸水量的变化、胸水中癌胚抗原(CEA)、细胞角蛋白K19片段(CYFRA21-1)、神经元特异性烯醇化酶(NSE)浓度变化和不良反应。结果治疗组、对照组有效率分别为100%和54.3%,差异有统计学意义(χ2=3.65,P<0.05),治疗组治疗后胸水中CEA、CYFRA21-1、NSE浓度较治疗前明显下降(t=2.76,P<0.05),治疗后治疗组较对照组明显降低(P<0.05),两组各种不良反应比较差异无统计学意义(P>0.05)。结论胸腔镜辅助下胸腔内高温灌注化学治疗肺癌恶性胸腔积液安全、效果可靠,创伤小、视野大,能直视下分离粘连,并准确对胸膜病变活检,对肺癌恶性胸腔积液患者有较高的应用价值。
Objective To explore the methods of thoracoscopic intrapleural perfusion hyperthermic chemotherapy（TIPHC） on diagnosing and treating malignant pleural effusion caused by lung cancer, as well as its effect. Methods From February 1999 to March 2006, seventy patients with malignant pleural effusion caused by lung cancer were randomly divided into therapeutic group（35 cases） and control group（35 cases）. Pleural biopsy and TIPHC under general anesthesia with unilateral ventilation were performed in the therapeutic group, and intrapleural injection of cisplatin was administered in the control group after drainage of pleural effusion. The effect on malignant pleural effusion, the change for the concentration of carcino - embryonic antigen （CEA） , cytokeratin - 19 fragments （ CYFRA21 - 1 ） , neuron- specific enolase（NSE） and the side effect were compared before and after the treatment. Results The therapeutic group achieved total response rate of 100% , but only 54： 3% in the control group, with significant difference（ P 〈 0.05）. Furthermore, the concentration of CEA,CYFRA21 - 1 and NSE in the therapeutic group dramatically deoreased comparing with those of the control group（P 〈 0. 05）. But there was no significant difference in side effect（P 〈 0. 05 ）. Conclusion TIPHC has the advantage of both diagnosis and treatment of malignant pleural effusions. It is safe and effective, and also able to determine the pathological diagnosis. Furthermore, It offers the superiority of small wound,best visualization,convenient pleural biopsy,breaking up adhesions with confirmation of complete lung expansion under direct vision.
出处
《医学研究杂志》
2008年第12期58-61,共4页
Journal of Medical Research
关键词
胸腔镜
胸腔内高温灌注化学治疗
肺癌
恶性胸腔积液
Thoracoseopy
Intrapleural perfusion hyperthermic chemotherapy
Lung cancer
Malignant pleural effusion
