胸腔内留置导管注入羟基喜树碱卡铂及IL-2治疗恶性胸腔积液临床分析

Clinical observation on malignant pleural effusion treated by intrapleural perfusion of carboplatin combined with interleukin-2

目的比较胸腔内静脉导管留置注入羟基喜树碱联合卡铂及白细胞介素-2(IL-2)和卡铂及白细胞介素-2(IL-2)治疗恶性胸腔积液的临床疗效及不良反应。方法46例经病理组织学或细胞学确诊的恶性胸腔积液患者,随机分为两组:两组均采用改良的Seldinger法经皮穿刺,将一次性单腔中心静脉导管置入胸腔并保留,在胸腔积液引流干净后。治疗组24例:由导管注入羟基喜树碱和卡铂和IL-2;对照组22例:由导管注入卡铂和IL-2。注药后两组均夹管5天后再引流,无积液引出后再注入上述药物,夹管保留5天,一般注药2～4次。4～6周后复查B超、胸片,评价疗效。结果治疗组恶性胸腔积液治疗有效率91.7%(22/24);对照组恶性胸腔积液治疗有效率63.6%(14/22),差异有显著性(P<0.05);两组不良反应均较轻微,差异无显著性(P>0.05)。结论羟基喜树碱联合卡铂及白细胞介素-2较卡铂及白细胞介素-2胸腔内注入治疗恶性胸腔积液有效率较高且不良反应轻微,值得进一步推广应用。

Objective To evaluate the therapeutic effect and safety of hydroxycamptothecin combined with carboplatin and inter-leukin-2 in the treatment of malignant pleural effusion. Methods 46 patients diagnosed by pathohistology and cytology with malignant pleural effusion were treated and divided into the treatment group （24 cases） and the control group （22 cases） randomly. The PICC tube was inserted into the pleural cavity by pleurocentesis and drained continuously. Intrapleural therapy was given for the patients with HCPT, CBP,IL-2 for the treatment group, and for the control group with CBP, IL-2, then clamped the tube for 5 days and drained it completely. Reinjection above medicine was repeated 2-4 times. Type-B ultrasonic and the chest X-ray were performed after 4 - 6 weeks, and were evaluated for the results of therapy. Results The total effective rate was 91.7 % （22/24） in the treatment group, and 63.6% （14/22） in the control group. （P 〈0. 05）. The adverse effect was seldom in the two groups and there was no statistical difference（P 〉0. 05）. Conclusion The therapeutic effect of hydroxycamptuthecin combined with carboplatin and interleukin 2 in the treatment of malignant pleural effusion is obviously effective and safe. It is worthy of being applied widely in practice.