电视胸腔镜下胸膜固定术治疗非小细胞肺癌伴恶性胸腔积液

Clinical value of pleurodesis under video-assisted thoracoscopic surgery for treating the patients of non-small cell lung cancer with malignant pleural effusion

目的探讨电视胸腔镜下胸膜固定术治疗非小细胞肺癌伴恶性胸腔积液的临床应用价值。方法选取2009年1月至2012年6月江苏省肿瘤医院胸外科与肿瘤内科收治的57例非小细胞肺癌伴恶性胸腔积液患者入组。将胸外科的29例患者设为胸腔镜组,行电视胸腔镜下胸膜固定术;肿瘤内科的28例患者设为对照组,采用放置胸腔闭式引流、胸腔内注射粘连剂等方法治疗。对两组的疗效进行对比分析。结果胸腔镜组胸液控制有效率为93.10%(27/29),完全缓解率为79.31%(23/29)。对照组有效率为57.14%(16/28),完全缓解率为42.86%(12/28),两组疗效差异有统计学意义(P<0.001&P=0.005);与对照组相比,胸腔镜组患者术后KPS评分显著升高(P=0.002)。结论在非小细胞肺癌伴恶性胸腔积液的综合治疗中,胸腔镜下胸膜固定术在有效控制恶性胸腔积液、提高患者生存质量方面明显优于胸腔闭式引流术。

Objective To explore the clinical value of pleurodesis under video-assisted thoracoscopic sur- gery （VATS） for treating the patients of non-small cell lung cancer with malignant pleural effusion（MPE）. Methods 57 patients with non-small cell lung cancer（NSCLC） with MPE who admitted into our hospital from January 2009 to June 2012 were enrolled in this study. 29 cases of the department of thoracic surgery were set to thoracoscopic group ; another 28 cases of the oncology department were set to control group. Patients in the tho- racoscopic group were treated with pleurodesis under VATS; patients in the control group were treated with tho- racentesis, placed closed thoracic drainage, or intrapleural injection treatment of adhesions, etc. Treatment ef- fectiveness of these two groups was statistically analyzed. Results The response rate of thoracoscopic group and control group were 93.10% （27/29） and 57.14% （23/29） respectively （P 〈 0. 001 ）, and the complete remis- sion rate were 79.31% （ 16/28 ） and 42.86% （ 12/28 ） respectively （ P = 0. 005 ）. As compared with control group, the improved values of KPS scores in VATS group were significantly increased （ P = 0. 002）. Conclu- sions Pleurodesis under VATS can effectively control MPE and improve the quality of life for NSCLC patients with MPE in comparison with the method of traditional tube drainage only.