亚砷酸胸腔灌注联合体外高频热疗治疗癌性胸水

Extracorporeal High-frequency Hyperthermia Combined with Pleural Cavity Infusion of Arsenic Trioxide Treating Patients with Malignant Pleural Effusion

目的观察亚砷酸胸腔内灌注联合体外高频热疗对癌性胸水的疗效。方法连续纳入45例癌性胸水病例,采用抽签法分为A、B、C 3组。所有患者均尽量引流胸水(至引流量小于150 m l/d),A组经导管向胸腔内灌注亚砷酸20 mg,后拔除导管并于当日行胸腔局部热疗1次,以后隔日热疗1次,连续4次;B组仅予胸腔内灌注亚砷酸20 mg并拔除导管;C组于胸水引净后拔除导管,并于当日行胸腔局部热疗1次,以后隔日热疗1次,连续4次。在拔管4周后复查胸水量,观察3种方法对癌性胸水的疗效及毒性反应。结果治疗后A、B、C 3组有效率分别为86.7%,62.5%和50.0%,A组胸水疗效优于B组和C组(P<0.05)。治疗后3组胸水LDH均较各组治疗前升高,均有显著性差异(P<0.01,P<0.05),以A、B两组胸水LDH升高明显。治疗后A、B两组胸水CEA均较各组治疗前降低,均有显著性差异(P<0.01),以A组胸水CEA下降明显。治疗后3组患者均未出现血液学、心脏、肝脏、肾脏等毒性反应。结论亚砷酸胸腔内灌注联合体外高频热疗控制癌性胸水具有协同增效作用,毒副反应小,患者易于耐受。

Objective To observe the efficacy of extracorporeal high-frequency hyperthermia combined with pleural cavity infusion of Arsenic Trioxide in patients with malignant pleural effusion.Methods Forty-five patients with malignant pleural effusion were enrolled and divided into three arms by ballot：A,B and C.After the accumulation of pleural fluid had been adequately drained,Arm A received pleural cavity infusion of Arsenic Trioxide 20mg followed by extracorporeal high-frequency hyperthermia once every two days for four times. In Arm B, all patients were treated only with pleural cavity infusion of Arsenic Trioxide 20mg. In Arm C, patients were only given extracorporeal high - frequency hyperthermia once every two days for four times. The efficacy of pleural effusion and toxic reactions were recorded and compared after four weeks. Results The overall response rate of the three group were 86.7% ,62.5% ,50% respectively. And the efficacy of pleural effusion of A arm was better than B and C arm＇s（P 〈 0.05 ）. The levels of LDH in pleural effusion of post - treatment in three arms were all higher than those of prior - treatment. And there were statistically significant difference respectively between prior- treatment and post- treatment（ P 〈 0.05, P 〈 0.01 ）. Those of Arm A and Arm B increased significantly. The levels of CEA in pleural effusion of post - treatment in Arm A and Arm B were all lower than those of prior - treatment. And there were statistically significant difference respectively between prior - treatment and post -treatment（ P 〈 0.01 ）. Those of Arm A reduced significantly. All the patients had no blood, heart, liver, kidney and other toxic reactions. Conclusion The efficacy to malignant pleural effusion of extracorporeal high - frequency hyperthermia combined with pleural cavity infusion of Arsenic Trioxide is better than those of the method of pleural cavity infusion of Arsenic Trioxide and high - frequency hyperthermia. The first method has combined synergies. The treatment is well tolerated with no adverse toxic reaction.