腹腔热灌注化疗联合高频热疗治疗恶性腹水

Clinical Study of Chemotherapeutic Hyperthermic Intraperitoneal Perfusion Combined with High Freguency Hyperthermia for the Treatment of Malignant Ascites

目的:观察腹腔热灌注化疗联合热疗治疗恶性腹水的疗效及其副反应。方法:恶性腹水47例,随机分为治疗组及对照组。腹腔穿刺后连接负压引流器,引流干净腹水后,治疗组给予43-45℃的生理盐水500 ml+顺铂60 mg/m2、生理盐水1 000 ml+5-氟尿嘧啶500 mg/m2,快速灌注入腹腔,使进入腹腔的液体温度维持在42-44℃;灌注结束后,采用HG-2000型高频热疗机行腹腔热疗41-43℃,60 min,每周热疗2次;对照组给予生理盐水60ml+顺铂60 mg/m2、生理盐水100 ml+5-氟尿嘧啶500 mg/m2腹腔内注入。两组均于1 h内完成,每周灌注1次,连续灌注2周,评定疗效。结果:治疗组有效率65.2%,卡氏评分(KPS)升高率47.8%;对照组有效率45.8%,KPS升高率33.3%。治疗组腹水控制率、KPS升高率均较对照组明显为优(P<0.05)。两组副反应无明显差异。结论:腹腔热灌注化疗联合热疗治疗恶性腹水较单纯腹腔化疗疗效好,可以耐受。

Objective： To evaluate the effects and toxicities of the chemotherapeutic hyperthermic intraperitoneal pedusion （CHIP） combined with hyperthermia for the treatment of malignant ascites. Methods. Fortyseven cases of malignant ascites were randomly divided into treatment group and control group. Normal saline （NS, 500 ml） ＋ Cisplatin （60 mg/m^2） and 1 000 ml NS ＋ 5-FU 500 mg/m^2 for two weeks at 43-45℃ were infused rapidly into abdominal cavity in an hour in treatment group after ascites were drained by petitoneocentesis, then the patients were treated with hyperthermia by external high frequency thermo-therapeutic apparatus HG-2 000 （60 min, twice a week）. Whereas 0. 9% NS 60 ml ＋ Cisplatin 60 mg/m^2 and 0.9% NS 1013 ml ＋ 5-FU 500 mg/m^2 were given in control group without heating. Results： KPS scale increasing rate was 47.8%（11/23） and the response rate of ascites was 65.2% in treatment group versus 33. 3%（8/24） and 45.8% in control group respectively （both P（0.05）, but the side-effects rate was the same and there were no grade 3 or 4 toxicity in the two groups. Conclusion： The chemotherapeutic hyperthermic intraperitoneal perfusion and hyperthermia was more efficient in the treatment for malignant ascites than the chemotherapy intraperitoneal without heating, while the toxicity and the side-effects were tolerable.