胸腹腔留置中心静脉导管引流恶性积液临床观察

Clinical Observation of Malignant Belly Cavity and Intrapleural Liquid Led out Through Retain Center Vein Pipe

目的观察中心静脉导管留置引流控制恶性胸腹腔积液的临床疗效及毒副反应。方法本组40例,其中恶性胸腔积液28例,腹腔积液12例;肺癌12例,乳腺癌10例,卵巢癌5例,胃癌4例,结直肠癌4,淋巴瘤3例,恶性胸膜间皮瘤2例。所有病例均经组织病理学或细胞学确诊为恶性胸腹腔积液;彩超定位处将中心静脉导管留置胸、腹腔中,持续闭式负压引流至抽尽胸、腹水,并通过导管注入化疗药物顺铂、羟基喜树碱、白介素-Ⅱ、地塞米松、氟脲嘧啶、新福菌素、多抗甲素等。结果全组40例中CR14例（35%）,PR17例（42.5%）,PD9例（22.5%）,总有效率（RR）77.5%（31/40）,中位缓解期4个月（1月-3年）,生活质量明显改善,无明显毒副反应。结论应用中心静脉导管装置引流控制恶性胸腹腔积液操作安全、简便、创伤小、保留时间长,能最大限度地排净胸腹腔积液,避免反复多次胸腹腔穿刺给患者带来危险和痛苦,对控制恶性胸腹腔积液有较好的疗效,毒副反应轻,能改善患者生活质量。

Objective To observe the clinical efficacy and toxicity in treatment of malignant belly cavity and intrapleural liquid led out through retain center vein pipe. Methods 40 patients with malignant belly cavity and intrapleural liquid, 18 cases male, 22 cases female, age from 22 to 75 years old, average age was 50 years old, cases with lung cancer were 12, cases with breast cancer were 10, cases with ovary cancer were 5, cases with gastric cancer were 4,cases with colon cancer were 4,cases wiyh lymphoid lumps were 3 and cases with malignant pleural mesotheliomae were 2. All the patients were diagnosed definitely by pathology and cytology. All the patients were through colorultrasonic fixing position of puncture, and the center vein pipe was catheterized and led out malignant liquid then injection of PDD, HCPT, rIL-2, DXM, 5-Fu, ACTD. Results CR were 14 cases （35%） , PR were 17 cases （42.5%） , PD were 9 cases （22.5%）. Overall response rate （CR ＋ PR） was 77.5% , the median survival period was 3 months, the quality of life was obviously improved and no toxicity. Conclusions The center vein pipe catheterized in treatment of malignant belly cavity and intrapleural liquid was safe, simple no toxicity and avoided repeated puncture and was better efficacy, improved the quality of life. It is worth studying in the future.