胸腔内置管并灌注顺铂治疗肺癌致胸腔积液的临床研究

Intrapleural catheter placement and intrapleural administration of cisplatin for pleural effusion in lung cancer

目的比较经皮胸腔内置管和常规胸腔穿刺抽液并胸腔内灌注顺铂治疗恶性胸腔积液的效果,探讨胸腔内置管治疗恶性胸腔积液的临床应用价值。方法将2008年1月—2011年10月确诊为肺癌致胸腔积液的患者82例,随机分为治疗组42例和对照组40例,治疗组患者采用经皮胸腔内置管引流胸腔积液,对照组采用常规胸腔穿刺抽液方法引流胸腔积液,两组均行胸腔内灌注顺铂化疗,1次/4 d,连续灌注3～4次,比较两组患者的治疗效果。组间比较采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果总有效率治疗组95.2%,对照组30.0%,两组比较差异有统计学意义(χ2=37.584,P<0.05)。治疗组平均临床费用(1345.54±5.31)元、平均住院时间(14.78±2.41)d,对照组分别为(1617.36±6.32)元、(17.92±4.23)d,两组比较差异均有统计学意义(t=211.245、4.155,均P<0.05)。胸腔内置管患者发生小量气胸1例,置管局部发红1例。结论经胸腔内置管引流胸腔积液并胸腔内灌注顺铂治疗恶性胸腔积液,疗效确切,应用方便,提高了生存质量,值得推广。

Objective To compare the clinical efficacy of intrapleural administration of cisplatin through intrapleural catheter and conventional thoracentesis for pleural effusion in lung cancer,and to discuss the clinical value of intrapleural catheter in the treatment of malignant pleural effusion.Methods Eighty-two patients who had been diagnosed as lung cancer with pleural effusion were recruited from October 2011 to January 2008.They were divided into two groups randomly：treatment group（n=42）and control group（n=40）.Treatment group received intrapleural catheter placement for drainage,while control group underwent conventional thoracentesis.Both groups were given intrapleural administration of cisplatin,once every four days,for 3~4 successive times.The clinical efficacy were compared in both groups.The t-test was used for the comparison between groups,and χ2-test for count data,the result of P〈0.05 was considered statistically.Results The total effective rate was 95.2% in treatment group and 30.0% in control group,which showed significant difference（χ2=37.584,P〈0.05）.The average medcial cost was（1 345.54±5.31）yuan and the average length of hospital stay was（14.78±2.41）d in treatment group,which were significantly different from those in control group[1 617.36±6.32 yuan,17.92±4.23 d]（t= 211.245,4.155,both P〈0.05）.Mild pneumothorax developed in one case,and local infection in puncture site occurred in one case.Conclusions The intrapleural cisplatin treatment through intrapleural catheter for malignant pleural effusion is effective,convenient,and can improve quality of life,which is worthy to be applied clinically.