热疗联合胸腔置管化疗治疗恶性胸腔积液临床研究

Clinical study on thermotherapy combined with chest cavity intubation chemotherapy for treatment of malignant pleural effusion

目的观察热疗联合胸腔置管化疗治疗恶性胸腔积液的临床疗效及其毒副反应。方法62例恶性胸腔积液患者随机分为射频热疗联合胸腔置管化疗组(治疗组)和单纯胸腔置管化疗组(对照组)各31例。对照组先行胸腔闭式引流后,将顺铂60 mg、氟尿嘧啶1.0 g、吡喃阿霉素40 mg各加生理盐水50 ml胸腔内注射,再将地塞米松20 mg胸腔内注射后夹管,每周1次,灌注2次后拔管观察,治疗组于胸腔注射药物后行热疗,当周再行1次单纯热疗,一疗程4次。结果对照组胸腔积液控制有效率为54.8%,治疗组为83.9%,两组差异有显著性(P<0.05)。对照组生活质量改善率为48.4%,治疗组为77.4%,两组差异有显著性(P<0.05)。两组化疗毒副反应发生率差异无显著性。与热疗相关的毒副反应为局部皮肤疼痛4例(13.0%),皮下脂肪硬结3例(9.7%)。结论热疗联合胸腔置管化疗治疗恶性胸腔积液是一种安全可靠、高效低毒的治疗方法,值得临床推广使用。

Objective To observe clinical efficacy and toxic side effect of thermotherapy combined with chest intubation chemotherapy in treatment of malignant pleural effusion. Methods Sixty-two patients with malignant pleural effusion were divided randomly into the radiofrequency thermotherapy combined with chest cavity intubation chemotherapy group （treatment group） and the only chest cavity intubation chemotherapy group （control group）. Each group consisted of 31 patients. In the control group, after chest cavity closed drainage, cisplatin 60 mg, fluorouracil 1.0 g, pyranoadriamycin 40 mg in physiological saline 50 ml each were injected into chest cavity, then after injection of dexamethasone 20 mg into chest cavity, the tube was clamped. The treatment was once every week and the tube was withdrawn after perfusion twice for observation. The treatment group received thermotherapy after injection of the drugs into chest cavity. Thermotherapy was given once again in this week, one treatment course consisted of 4 times. Results The effective rate of controlling pleural effusion was 54. 8% in the control group and 83.9% in the treatment group, with significant difference betwee the 2 groups （P 〈 0. 05）. The life quality improvement rate was 48.4% in the control group and 77.4% in the treatment group, with significant difference between two groups （ P 〈 0. 05 ）. The incidence of chemotherapy toxic side reaction showed no significanct difference between the 2 groups. The toxic side reactions related to thermotherepy were local cutaneous pain in 4 patients （ 13.0% ） and subcutaneous fat hard nodule in 3 patients （9.7%）. Conclusion Thermotherapy combined with chest cavity intubation chemotherapy for treatment of malignant pleural effusion is a kind of safe, reliable, highly effective and low toxicity method of treatment, and is worthy of populization for the clinical use.