鸦胆子油乳联合顺铂持续循环腹腔热灌注治疗恶性腹水的临床研究

Clinical efficacy of cisplatin hyperthermic intraperitoneal perfusion chemotherapy combined with brucea javanica oil emulsion for malignant ascites

目的探讨鸦胆子油乳联合顺铂持续循环腹腔热灌注治疗恶性腹水的近期疗效,并分析其不良反应及相关并发症。方法27例恶性腹水患者通过超声引导下、开腹及腹腔镜辅助下腹腔置管,先行持续腹腔热灌注治疗(生理盐水2 000 ml+顺铂50 mg/m2)4次,于末次灌注化疗结束后排净灌洗液,经导管注入43℃生理盐水100 ml+地塞米松15 mg+鸦胆油乳100 ml后拔管。评估鸦胆子油乳联合顺铂持续循环腹腔热灌注对恶性腹水的临床疗效及安全性。结果本组27例恶性腹水患者治疗后,腹胀症状明显改善,超声检查腹水显著减少。治疗组中完全缓解者18例,部分缓解者7例,稳定者2例,总体有效率高达92.6%(25/27)。治疗过程中无III或IV级严重毒副反应,无肠粘连和肠梗阻等治疗相关并发症发生。结论鸦胆子油乳联合顺铂持续循环腹腔热灌注治疗恶性腹水,安全、微创、不良反应少而轻、近期疗效明显。

Objective To investigate the effect and safety of cisplatin hyperthermic intraperitoneal perfusion chemotherapy(HIPC) combined with brucea javanica oil emulsion for malignant ascites.Methods Twenty-seven patients with malignant ascites first received four cycles of continuous HIPC(saline 2000 ml +cisplatin 50 mg / m2),then a mixture of 100 ml saline,15 mg dexamethasone and 100ml brucea javanica oil emulsion was injected into the abdominal cavity after the last treatment of HIPEC.The clinical efficacy and safety were assessed.Results After HIPC combined with brucea javanica oil emulsion,the subjective symptom such as abdominal distension was alleviated,and objective indexes including the abdominal circumference and volume of malignant ascites were reduced significantly in all27 patients.The complete response(CR) was observed in 18 cases(66.7%),partial response(PR) in7 cases(25.9%),stable disease(SD) in 2 cases(7.4%),and no case developed progressive disease(PD).The total response rate reached 92%(25 / 27).There were no serious( Ⅲ or Ⅳ grade) adverse events of chemotherapy,and no HIPC-related complications such as intestinal adhesion and obstruction during the treatment period.Conclusion Cisplatin HIPC combined with brucea javanica oil emulsion for malignant ascites was safe and effective,with less adverse events of chemotherapy and HIPEC-related complications.