胸腔注入尿激酶联合局部化疗治疗恶性包裹性胸腔积液的临床观察

Treatment of encapsulated malignant hydrothorax by combined thoracic urokinase infusion and local chemotherapy

目的探讨胸腔注入尿激酶联合局部化疗治疗恶性包裹性胸腔积液的有效性和安全性。方法 82例恶性包裹性胸腔积液患者随机分为两组,治疗组42例,胸腔置管引流全部积液后予尿激酶20万U胸腔注入,2次/周,1周后充分引流,胸腔注入博莱霉素、白细胞介素-2。对照组40例,胸腔置管充分引流后,直接向胸腔注入博莱霉素、白细胞介素-2。每次胸腔化疗1周为1周期,两组均在2周期后评价疗效。治疗组于治疗前后测定活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)等凝血及纤溶指标。结果治疗组显效10例、有效17例,总有效率64.3%;对照组显效2例、有效11例,总有效率32.5%,两组差异有统计学意义(P<0.05)。治疗组治疗前后APTT、PT、TT、FIB比较差异均无统计学意义(P>0.05)。两组均未出现胸腔或全身出血等严重并发症。结论胸腔注入尿激酶联合局部化疗是治疗恶性包裹性胸腔积液安全、有效的方法。

Objective To study efficacy and safety of combined thoracic urokinase infusion and local chemotherapy for encapsulated malignant hydrothorax. Methods Eighty-two patients with encapsulated malignant hydrothorax were divided into treatment group （n=42） and control group （n=40）. Patients in treatment group were treated by thoracic infusion of 200 000U urokinase （twice a week） followed by thoracic infusion of bleomycin and interleukin-2 while those in control group were treated by direct infusion of bleomycin and interleukin-2 after all dropsy was drained from thorax with a thorax-dwelling tube. Their clinical outcome was assessed two weeks after chemotherapy. Activated partial thromboplastin time （APTT）, prothrombin time （PT）, thrombin time （TT）, and fibrinogen （FIB） in treatment group were detected before and after treatment. Results The excellent and good clinical outcome was achieved in 10 and 17 patients of treatment group respectively with a total effective rate of 64.3%, and in 2 and 11 patients of control group respectively with a total effective rate of 32.5% （P〈0.05）. No significant difference was found in the APTT, PT, TT, and FIB of treatment group （P〉0.05） and no severe complications such as thorax and systemic bleeding occurred in two groups. Conclusion Combined thoracic urokinase infusion and local chemotherapy is an effective and safe treatment modality for encapsulated malignant hydrothorax.