胸膜固定术联合培美曲塞治疗老年非小细胞肺癌并发恶性胸腔积液的临床观察

Efficacy of pleurodesis combined with pemetrexed on elderly patients with malignant pleural effusion caused by non-small cell lung cancer

目的观察局部胸膜固定术联合培美曲塞全身化疗治疗老年非小细胞肺癌(NSCLC)并发恶性胸腔积液的有效性和安全性。方法 64例老年NSCLC并发恶性胸腔积液患者随机分为A、B两组,治疗前均采用中心静脉导管行胸腔置管闭式引流术。A组31例,仅行局部胸膜固定术,具体为:香菇多糖4mg+顺铂40mg/m2,局部胸腔注入,每周1次,连续2～3周。B组33例,在A组治疗的基础上再给予单药培美曲塞全身化疗,具体方案为:培美曲塞500mg/m2d1,3周为1周期,共2周期。结果 A组胸腔积液缓解有效率为64.6%,B组为87.9%,差异有统计学意义(P<0.05);A组KPS评分改善率为71.0%,B组为90.9%,差异有统计学意义(P<0.05)。两组患者毒副反应均较轻,其中B组白细胞减少的发生率为36.4%,高于A组的12.9%(P<0.05)。结论局部胸膜固定术联合培美曲塞全身化疗治疗老年NSCLC并发恶性胸腔积液疗效优于单纯胸膜固定术,且毒副反应轻微,易耐受。

Objective To evaluate the clinical efficacy and adverse reaction of pleurodesis combined with pemetrexed on elderly patients with malignant pleural effusion caused by non-small cell lung cancer（NSCLC）.Methods Sixty-four elderly patients with malignant pleural effusion caused by NSCLC were randomly divided into group A（31 cases）and group B（33 cases）,and treated by closed thoracic drainage with central venous catheters and intrathoracic therapy with drugs.After drainage,lentinan 4mg/m2 and cisplatin 40mg/m2were injected into pleural cavity in the both two groups（once weekly,for two or three weeks）;while single drug chemotherapy of pemetrexed was added to patients in group B（pemetrexed 500mg/m2 d1,three-week was a cycle for two cycles）.Results The pleural effusion remission rate of group A and B was 64.6% and 87.9%（P〈0.05）;the KPS score improvement rate of group A was 71.0%,lower than 90.9% in group B（P〈0.05）.All toxicities were mild and controllable.The incidence of leukopenia in group A was 12.9%,much lower than 36.4% in group B（P〈0.05）.Conclusion Pleurodesis combined with pemetrexed treating elderly patients with malignant pleural effusion caused by NSCLC is better than pleurodesis treatment alone,and adverse reactions are mild.