肺癌恶性胸水胸腔镜辅助下局部肿瘤切除胸膜热烧灼后胸水及血液肺癌标志物变化

Tumor marker changes of pleural effusion and serum after pleura thermal ablation in local tumor excision under thoracoscopy for lung cancer with malignant pleural effusion

目的从肺癌相关肿瘤标志物的角度评价胸腔镜辅助下局部肿瘤切除联合胸膜热烧灼治疗肺癌恶性胸水的临床效果。方法 2005年6月至2010年6月对35例肺癌伴恶性胸水患者完成了胸腔镜辅助下局部肿瘤切除胸膜热烧灼为主的综合治疗。观察治疗前后胸水及血清肺癌标记物浓度变化情况,并与同期26例胸腔化疗患者进行对比。结果手术组与胸腔化疗组中位数生存期分别为20.2个月13.7个月。两组比较差异有统计学意义(P<0.01)。手术组患者的胸腔积液控制有效率高于胸腔化疗组(100%vs 57.7%,P<0.01);手术组术后胸水癌胚抗原(CEA)、糖链抗原125(CA-125)、细胞角质蛋白19血清片段21-1(Cyfra21-1)较胸腔化疗组治疗后降低(均P<0.05)。分别是(27.4±5.6)μg/L vs(140.6±49.7)μg/L、(86.5±10.7)μg/L vs(590.7±90.7)μg/L、(48.2±9.9)μg/L vs(57.9±20.6)μg/L。而胸腔化疗组治疗后较治疗前CEA、CA-125、Cyfra21-1及NSE下降明显,但CA-125下降不明显(P>0.05)。手术组治疗后血CEA、CA-125、Cyfra21-1及神经特异性烯醇化酶较治疗前明显下降(P<0.05或<0.01)。而胸腔化疗组治疗后Cyfra21-1、NSE与治疗前比较变化不明显(P>0.05)。结论胸腔镜辅助下局部肿瘤切除联合胸膜热烧灼对肺癌恶性胸水有明显治疗效果。

Objective To study the treatment effect of wedge resection and thermal cautery of pleura for patients with malignant pleural effusion（MPE）caused by lung cancer under thoracoscopy through related tumor markers. Methods From June 2005 to June 2010,35 patients with MPE underwent wedge resection and thermal cautery of pleura under thoracoscopy. The preoperative and postoperative tumor markers level, the control rate of pleural effusion were compared with those of control group,including 26 patients undergoing intrapleural chemotherapy in the same period. Results The median survival time for the operation group and control group was respectively 20.2 months and 13.7 months（ P d0.01）. The control rate of pleural effusion was 100% and 57.7% for the operation group and chemotherapy group respectively（ P 〈0. 01）. The carcino-emhryonic andgen（CEA）, carbohydrate antigen125（CA-125）, cytokeratin 19 fragments（Cyfra21-1） levels of pleural effusion in operation group were decreased obviously than those of control group,respectively （27.4±5.6） μg/L vs （140.6±49.7） μg/L, （86.5±10.7） μg/L vs （590.7±90.7） μg/L,（48. 2±9. 9） μg/L vs （57.9±20.6） μg/L（ P 〈0.05）. But the CA-125 level of pleural effusion was not decreased obviously after operation for the chemotherapy group（ P〈0.05）. The serum CEA, CA-125, Cyfra21-1 and neuron specific enolase level of the operation group decreased obviously after operation（ P 〈0.01）, but Cyfra21-1 and NSE did not change in the chemotherapy group（ P 〈0.01）. Conclusion The wedge resection combined with thermal cautery of pleura under thoracoscopy was obviously effective for lung cancer with MPE.