心包置管引流时间对肺癌心包转移疗效的影响

Effect of different duration of pericardial catheter drainage on the outcome of lung cancer patients with malignant pericardial effusion

目的探讨不同心包内置管引流时间对肺癌伴恶性心包积液心包填塞的，临床疗效和安全性。方法将入选的88例患者随机分为A、B两组。A组44例，为长时间置管组，置管时间为〉4周；B组44例，为短期置管组，置管时间〈4周。两组患者均接受相同的心包注射和全身静脉注射药物治疗方案，分别观察6个月内的疗效、生存时间、复发率、生存率及置管并发症发生率。结果A、B两组近期完全缓解率（54．55％VS36．36％，χ2=2．93，P=0．09）和部分缓解率（36．36％vs34．91％，χ2=0．90，P=0．87）差异均无统计学意义，但总有效率比较差异有统计学意义（90．91％vs70．45％，χ2=5．91，P=0．02），OR=4．19，95％CI：1．24—14．13。半年内的复发率A、B两组分别为20．45％和38．63％（χ2=3．91，P=0．04）。A、B两组中位生存时间分别为7．96、3．52个月，生存率分别为72．47％和51．38％（Logrank=4．76，P=0．04）。两组患者穿刺部位化脓感染发生率分别为4．55％和2．77％（χ2=0．34，P〉0．05）。两组患者均未发现心包化脓感染、窦道形成及严重粘连等并发症。结论适当延长心包置管引流时间，可提高治疗效果，安全性高，可作为肺癌心包积液的首要治疗方法。

Objective To evaluate the early effects and safety of prolonged implanted catheter in pericardium on the patients with lung cancer and perieardial transmission. Methods Eighty - eight cases enrolled were randomly devided into two groups （ group A and group B）, the period of implanted catheter was more than four weeks in group A and less than four weeks in group B. The treatment protocal of the two groups was the same, then to observe the outcome, survival time of patients, the recurrence rate of pericardial effusion, the complications relevant to the catheter. Results The early complete relief rate （CRR） of two groups（ A and B） was of no statistical significance （χ2 = 2.93, P = 0.09）, but the total effective rate of two groups had a significant statistical difference（90.91% vs 70.45% ,X： =5.91, P = 0. 02） within OR = 4. 19, 95% CI （ confidence interval） ： 1.24 - 14.13. The recurrence rate of two groups half a year was 20.45 % vs 38.63 % , χ2 = 3.91, P = 0.04, the survival rate of group A and group B was 72. 47% and 51. 38% （Log rank = 4.76, P = 0. 04）. The median survival period of two groups within half a year was 7. 96 months and 3.52 months. There were no difference in complication（4.55% vs 2.77% ,χ2 =0.34, P 〉 0.05） ,and there were not pyogenie infection in pericardium, fistula formation, peniearditis severe pericardiosymphysis and myocardial injury. Conclusions The moderate prolonged time of catheter drainage treatment is an effective and safe approach for lung cancer patients with pericardial transmission, it can he the main treatment.