胸腔镜与引流术治疗非小细胞肺癌伴恶性胸腔积液对比研究

Comparative study of video-assisted thoracoscopic surgery vs thoracic tube drainage in synthetic therapy for malignant pleural effusion secondary to non-small cell lung cancer

目的评价胸腔镜术在综合治疗肺癌伴恶性胸腔积液中的临床价值和手术适应证。方法53例非小细胞肺癌并恶性胸腔积液患者被单盲随机分为胸腔镜手术组(胸腔镜组)和闭式引流术组(引流组),两组均应用泰素联合伯尔定方案行全身化疗4个疗程观察,以胸腔积液疗效,生存质量和生存率为评价指标。结果胸腔镜组胸液控制有效率为92.3%,完全缓解率为88.5%;引流组有效率为59.3%,完全缓解率为44.4%,差异有统计学意义(P<0.05);每组治疗前后KPS评分差值的中位数在胸腔镜组为30分,均数为33.5±11.3,引流组中位数为20分,均数为24.07±10.5,两组差异有统计学意义(P<0.05)。随访到2005年8月,随访率100%,胸腔镜组中位生存时间为20个月,1年生存率65.4%,2年生存率38.5%,3年生存率22.4%;引流组中位生存时间为15个月,1年生存率59.3%,2年生存率25.9%,3年生存率14.8%,两组差异无统计学意义(P>0.05)。结论在非小细胞肺癌并恶性胸腔积液的综合治疗中,胸腔镜胸膜剥除术在有效控制恶性胸腔积液、提高患者生存质量方面明显优于胸腔闭式引流术,但在生存率方面无明显差异。除Ⅳ级胸腔积液外,Ⅰ、Ⅱ、Ⅲ级均为手术适应证。

Objective To study the value of video-assisted thoracoscopic surgery （VATS） and identify its indications in synthetic therapy for malignant pleural effusion secondary to non-small cell lung cancer. Methods A prospective randomized single-blinded controlled clinical trial was conducted. Fifty-three patients with moderate or large amount of ipsilateral malignant pleural effusion （MPE） secondary to non-small cell lung cancer （NSCLC） were randomly divided into VATS group and tube drainage group （TD group）. All patients received chemotherapy with the regimen of paclitaxel combined with paraplatin, and the response rate of MPE after therapy, difference of Kamofsky performance status （KPS） grades before and after therapy and the survival rate of the patients were compared. Results The response rate of MPE after therapy in VATS group and TD group was 92.3% and 59.3%, and the complete remission rate was 88.5% and 44.4% （P〈0.05）, respectively. The difference of KPS grades before and after therapy in VATS group and TD group were 30 and 20, with a mean of 33.5±11.3 and 24.07±10.5 （P〈0.05）, respectively. Till August of 2005 years, all patients were available for followed-up, whose median survival time was 20 months in VATS group and 15 months in TD group. The 1-, 2- and 3-year survival rate were 65.4%, 38.5% and 22.4% in VATS group and 59.3%, 25.9% and 14.8% in TD group （P〉0.05）, respectively. Conclusion Video-assisted thoracoscopic pleurectomy can effectively control MPE and improve the quality of life for NSCLC patients with MPE, but failed to significantly improve the patietns＇ survival rate in comparison with tube drainage. Except for grade Ⅳ, grades Ⅰ,Ⅱ and Ⅲ according to CT findings all can be indications of VATS.