微创置管引流奥沙利铂联合足叶乙甙心包腔内低张渗透压灌注治疗老年人恶性心包积液

Intrapericardium Hypotonic Etoposide and Oxaliplatin Treatment by Micro-tube Pericardiostomy for Malignant Pericardical Effusion in Aged Patients

目的：探讨微创置管序贯心包腔内奥沙利铂（L-OHP）、足叶乙甙（VP-16）低张渗透压灌注治疗老年人恶性心包积液的疗效及安全性.方法：29例老年恶性心包积液于B超定位下参用双腔中心静脉导管（PICC）心包穿刺置管引流术,排尽积液后,心包腔内序贯注入双蒸水、奥沙利铂100mg、VP-16 100mg, 1～2次/周,连续2～3周.结果：全组平均注药次数为3次.完全缓解18例（62.1%）,部分缓解11例（37.9%）,有效率93.3%,中位无进展生存时间7.3个月,微创置管化疗后多为I度胃肠道反应、I度骨髓抑制、窦性心律失常.结论：微创置管序贯心包腔内注射双蒸水、L-OHP、VP-16是治疗老年人恶性心包积液一种有效安全的方法.

Objective. To assess the effect and complication of intrapericardium hypotonic administration of etoposide and oxaliplatin in distilled water for malignant pericardical effusion in aged patients by micro-tube pericardiostomy. Methods. Twenty--nine patients with malignant pericardical effusion were treated with intrapericaridal infusion of distilled water （100 mL）, vp-16 （100mg） and lohp （100mg）, after draining off pericardical effusion as much as possible, by intrapericaridiocentesis with peripherally inserted double central venous catheter under contrast echocardiography. The patients were treated one or two times a week for two or three weeks. Results. Average infusion times of all cases were three, rate of complete response, partial response, over all response were 62.3 % （18 patients）, 31.04 % （9 patients） and 93.1 % respectively, and average of non-advanced survival time were 7.3 months , mainly Ⅰ grade of gastrointestinal tract reaction and myelosuppression or atrial arrhythmia. Conclusion： Intrapericardium hypotonic administration of vp-16 and lohp in distilled water for malignant pericardical effusion in aged patients by micro--tube pericardiostomy is an effective and safe treatment.