微创置管引流术联合甘露聚糖肽腔内灌注治疗恶性胸腹水的临床研究

Clinical research on mannatide intracavitary perfusion through minimal-trauma indwelling catheter treating malignant pleural or peritoneal effusion

目的探索中心静脉导管微创置管引流术联合甘露聚糖肽局部灌注治疗在机体状况差的晚期恶性胸腹水患者中应用的安全性和临床疗效。方法从2003年10月到2007年12月间,共对51例机体机能状况差(中位KPS评分40分)的晚期恶性胸腹水患者进行了中心静脉导管微创置管引流术联合甘露聚糖肽局部灌注治疗。在胸腹水引流完全后,经导管进行甘露聚糖肽的生物灌注治疗,甘露聚糖肽的剂量从20mg/次逐渐增加到50mg/次,每周灌注2次。结果经导管置管引流后,100%的患者与胸腹水压迫相关的临床症状得到明显缓解,胸腹水控制CR25例(49.0%,PR19例(37.3%),NC4例(7.8%),PC3例(5.9%),总有效率为86.2%(44/51)。中位带管时间63d(25～107d),中位积液无进展时间71d(0～248d),中位生存时间92d(25～265d)。37例患者(72.5%)经引流灌注后胸腹水得到控制而拔管,11例患者(21.6%)带管死亡。无置管相关死亡病例,与置管相关的并发症轻微,灌注药物后不良反应较轻,所有患者均能耐受治疗。生活质量改善明显,KPS评分改善者41例(80.4%),稳定者10例(19.6%),中位KPS评分提高到60分。结论中心静脉导管微创置管引流术联合甘露聚糖肽局部灌注治疗应用于机体状况差的晚期恶性胸腹水患者安全、有效,值得临床推广。

Objective To explore the safety and therapeutic effect of minimal-trauma indwelling central venous catheter com- bined with mannatide injection in treating advanced cancer patients with malignant pleural and peritoneal effusion. Methods From Oct 2003 to Dec 2007, the mannatide injection perfusion through an indwelling central venous catheter was performed for 51 poor healthy （medium KPS score： 40） advanced cancer patients who presented with symptomatic accumulation of malignant pleural or peritoneal effusions. The dose of mannatide increased gradually from 20 mg to 50 mg toties quotles, twice a week. Results In all cases, evacuation of the fluid with a central venous catheter significantly palliated the patients＂ symptoms; 25 cases （49.0%） at- tained complete regression, and 19 cases （37.3%） partial regression, 4 cases （7.8~~） no change （NC）, 3 cases （5.9%） progres- sion of disease, and the total effective rate was 86.2% （44/51）. Median catheter stay duration was 63 days （25-107 d）, median malignant effusion non-progressing time was 71 days （0-248 d）, and median survival was 92 days （25-265 d）. 37 cases （72. 5%） were extubated after the pleural or peritoneal effusion was controlled through evacuation and perfusion, while 11 cases （21.6%） ended with death prior to extubation. No indwelling catheter associated death occurred, indwelling catheter associated complica- tions were slight, adverse reaction was trivial after perfusion, and all patients could undergo the treatment safely. After therapy, quality of life was markedly improved. KPS grading increased in 41 cases （80.4%） and 10 cases （19. 6%） no changed. KPS grad- ing score attained 60. Conclusion As a safe, effective and useful technique for advanced cancer patients with malignant pleural effu- sion, mannatide perfusion through minimal-trauma indwelling central venous catheter deserves spreading in the clinic.