温热疗法治疗肺癌癌性胸水及其机制的临床研究

Clinical Study of Thermotherapy for Malignant Pleural Effusion Caused by Lung Carcinoma and Its Mechanism

目的 评价热疗肺癌癌性胸水的综合疗效，探讨肿瘤热疗的机制。 方法 采用４３±０．５℃温盐水胸腔循环灌注６０ ｍ ｉｎ，治疗３０ 例肺癌癌性胸水患者，随访观察对胸水的疗效、肺原发病灶变化、生活质量以及生存期，评价其临床综合疗效，同时利用光镜、电镜、末端脱氧核苷酰转移酶原位标记（ＴＵＮＥＬ）等技术，比较了热疗前后胸膜转移癌细胞的形态学和生化学改变。 结果 全组均只经一次热疗，胸水控制有效率达１００％ （ＣＲ９６．７％ ＋ ＰＲ３．３％ ），仅１ 例于热疗后１ 年胸水复发，余２９ 例分别随访２～３１ 个月无胸水复发。１３ 例热疗后复查ＣＴ，发现肺部原发灶缩小者５ 例。无手术死亡及并发症。全组１ 年存活率达８０．０％ ，３ 例分别达２９，２４，３１ 个月。２８例热疗后生活质量明显提高。光镜、电镜见胸膜转移癌细胞胞核固缩、碎裂和凋亡小体，ＴＵＮＥＬ见带亮黄色荧光的凋亡阳性细胞。 结论 温盐水胸腔循环灌注是肺癌癌性胸水安全、有效的新疗法；凋亡介导的肿瘤细胞热杀伤作用是肿瘤热疗的独特机制。

To assess the results of thermotherapy for malignant pleural effusion(MPE) caused by lung carcinoma and to explore the mechanism of thermotherapy for tumor.\ Methods\ 30 patients with MPE caused by lung carcinoma underwent operation with intrapleural hyperthermic circular perfusion of 43±0.5℃ saline for 60 minutes.\ The responses of pleural effusion and primary lung lump were followed up.\ The morphological and biochemical changes were detected by light microscopy、electron microscopy and TUNEL method.\ Results\ The total response rate was 100%(CR 96.7% and PR 3.3%). 29 cases had not recurrence of MPE, but one had recurrence of MPE 12 months after thermotherapy. 13 cases had been CT\|scaned once more after thermotherapy,the volume of primary lung lump in 5 cases dwindled.\ Neither operative death nor post\|operative complication had been found. \ The 1\|year survival rate was 80.0%,and 3 cases survived 29,24 and 31 months,respectively.\ And the quality of life in 28 cases had been improved significantly.\ The chromatin condensation、nucleola disintegration and apoptotic bodies were detected in lung carcinoma cell planting to pleural tissue.\ Conclution\ (1)The thermotherapy for MPE was a new,safe and effective treatment. (2)Apoptosis mediated cell killing was the particular principle of thermotherapy for tumor. \;