微创置管引流并甘露聚糖肽灌注治疗改善恶性胸腹水患者生活质量临床研究

The effect of mannatide perfusion through Minimal-Trauma indwelling on improving quality of life in malignant pleural or peritoneal effusions

目的采用EORTC-QLQ-C30(V3.0)中文版生活质量核心调查量表,问卷式调查评估微创胸腹腔置管引流术并腔内灌注甘露聚糖肽治疗方法对晚期恶性胸腹腔水(MPPE)癌症患者生活质量的影响。方法从2003年10月～2008年2月间,应用EORTC-QLQ-C30(V3.0)量表对69例接受该方法治疗的MPPE癌症患者进行了生活质量调查研究和评估。入组患者机体机能状况差,中位KPS评分40分,问卷式调查在治疗前和治疗后1个月进行。结果治疗后患者EORTC-QLQ-C30(V3.0)核心量表15项领域功能子量表中躯体功能、情绪功能和整体健康状况/生活质量标准分(SS)均有明显的提高,分别由21.11±7.74,41.17±13.98,23.56±19.42提高到42.94±29.56,50.00±18.18,64.11±12.01(P<0.01,P<0.05,P<0.01),差值有显著性统计学意义,改善率分别为71.01%,50.73%和72.46%。症状子量表和单项项目中,除便秘、腹泻单项SS治疗前后没有明显改变外,乏力、恶心/恶吐、疼痛、气短、失眠、食欲减弱SS均明显降低(P<0.05～P<0.01),改善率分别为69.57%,39.13%,68.12%,88.41%,47.83%和37.68%。经济困难者SS则明显升高(P<0.05),改善率仅为2.90%。胸腹水控制有23例CR(33.33%),37例PR(53.62%),6例NC(8.70%),3例PC(4.35%),总有效率为86.96%(60/69)。KPS评分由44.90±13.17提高到64.11±12.01(P<0.01),改善率为78.26%。结论中心静脉导管微创胸腹腔置管引流联合甘露聚糖肽腔内灌注治疗晚期MPPE,可以明显改善和提高MPPE患者的QOL水平,临床疗效较好,值得临床推广应用。

Objective To assess the effect of mannatide perfusion through minimal-trauma indwelling on improving quality of life （QOL）in malignant pleural or peritoneal effusions （MPPE） by EORTC-QLQ-C30（V3.0） Chinese version . Methods Between October 2003 and February 2008, the Mannatide injection perfusion through an indwelling central venous catheter was considered as a treatment possibility for 69 advanced cancer patients with MPPE presenting at our single department. All of the patients＇ performance statuses were hypo-function and the median Karuofsky performance status was 40 points. The questionnaire was administered at two points time of start treatment and one month weeks post-treatment. Results The standard score of functional scales in the physical ,emotion and global health and QOL functioning were statistically significant improver from 21.11±7.74,41.17±13.98 and 23.56±19.42 to 42.94±29.56,50.00±18.18 and 64.11±12.01 （P〈0.01 ,P〈0.05,P〈0.01 ）,respectively. Their improvement rates were 71.01%,50.73% and 72.46%,respectively. The standard score of symptom scales and singleitems in fatigue, nausea and vomiting, pain, dyspnea, sleep disturbance and appetite loss were statistically significant degraded. Their improvement rates were 69.57%, 39.13%, 68.12%, 88.41%, 47.83% and 37.68%, respectively. The financial impact item standard score improvement rate was 2.09%. The response rates of the malignant effusion therapeutic effect was 86.96 %（ 23 CR±37 PR/69）. KPS score was statistically significant improver from 44.90±13.17 to 64.11±12.01 （P〈0.01）. The KPS improvement rate was 78.26%. Conclusion Mannatide perfusion through Minimal-trauma indwelling central venous catheter could improve the QOL of advanced cancer patient with MPPE.It is a very safe, effective and useful technique for MPPE patients, particularly if system or region perfusion chemotherapy are not available.