双腔管引流胸腔内化疗治疗恶性胸水的临床研究

THE COMBINED USE OF DOUBLE-CHANNEL DRAINAGE AND INTRATHORACIC CHEMOTHERAPY TO TREAT MALIGNANT HYDROTHORAX

目的 探讨双腔管引流胸腔积液 ,并向胸腔内注入化疗药物治疗恶性胸水的治疗效果。方法 经B超定位或在B超引导下 ,将中心静脉导管经皮置入胸腔内 ,导管末端接上输液器及负压引流袋 ,缓慢排液 ,当胸水不再流出或流出量 <15 0ml/d时 ,经导管内注入顺铂 (DDP) 6 0～ 80mg ,阿霉素 (ADM ) 6 0mg或平阳霉素 (PYM)2 4～ 32mg。B超或X线观察 4周确无积液后拔管。结果 两组治疗后近期疗效对比 ,置管组明显优于胸穿组 ,总有效率分别是 94 .3% ,72 .3% ,两组有显著差异 (P <0 .0 5 )。结论 双腔管引流可最大限度排净胸水 ,使肺组织充分膨胀 ,脏层与壁层胸膜紧贴在一起 ,产生粘连 ,从而抑制大量渗出。注入抗癌药物后胸腔药物浓度高 。

Objective To explore the curative effects of the combined use of double-channel dratinage tube and intrathoracic chemtherapy to treat malignant hydrothorax.Methods Under the guidance of B-ultrasonorgraphy,the central venous catheter with transfusion system and negative pressure bag fixed to its end was place in the thoracic cavity percutaneously to drain the hydrops slowly.60～80mg of platinum and 60mg of adrimycin of 24～32mg of pingyangmycin were infused into the thoracic cavity through the catheters when no hydrops flowed out.Decannulation occurred when no discharge of hydrops were confirmed by B-ultrasonography of X-ray examination four weeks later.Results The treatment group showed better short-term curative effects than the contrast group treated with puncture.The total effective rates were 94.3% and 72.3% respectively(P<0.05).Conclusion The double-channel drainage tube can to the greatest extent drain away hydrops to greatly expand the thoracic tissues and to make splanchnic layer pleurae adhere firmly.Infusion of anticarciogen can promote the drug density to kill tumor cells effectively.As a result,pleural adhension can be formed to inhibit hydrop leakage.