支气管动脉热灌注化疗联合胸腔热灌注治疗肺恶性肿瘤合并恶性胸腔积液临床观察

Clinical Observation on Bronchial Arterial Hyperthermic Perfusion Chemotherapy Combined with Thoracic Hyperthermic Perfusion in Treatment of Patients with Pulmonary Malignant Tumor Accompanied by Malignant Pleural Effusion

目的探讨支气管动脉热灌注化疗联合胸腔热灌注治疗肺恶性肿瘤合并恶性胸腔积液的疗效。方法回顾性分析2013年2月—2015年2月收治的经临床病理确诊的晚期肺癌合并恶性胸腔积液69例的临床资料,根据治疗方案分为观察组38例和对照组31例。对照组给予胸腔热灌注治疗,观察组在对照组基础上给予支气管动脉热灌注化疗。评估两组临床疗效及化疗毒副反应,评定卡氏评分(KPS),检测胸腔积液白介素-10(IL-10)、白介素-4(IL-4)、白介素-2(IL-2)、γ-干扰素(IFN-γ)水平;随访6个月,记录患者的生存率。结果观察组总有效率和6个月生存率高于对照组(P<0.05)。两组治疗后KPS、IL-2、IFN-γ均较治疗前升高,且观察组高于对照组(P<0.05)。两组治疗后IL-10、IL-4较治疗前降低,且观察组低于对照组(P<0.05)。两组治疗后化疗毒副反应发生率比较差异无统计学意义(P>0.05)。结论支气管动脉热灌注化疗联合胸腔热灌注治疗肺恶性肿瘤合并恶性胸腔积液,可调节Th1/Th2失衡状态,近期疗效确切。

Objective To investigate curative effect of bronchial arterial hyperthermic perfusion chemotherapy combined with thoracic hyperthermic perfusion in treatment of patients with pulmonary malignant tumor accompanied by malignant pleural effusion. Methods Clinical data of 69 patients with advanced lung cancer accompanied by malignant pleural effusion confirmed by clinical pathology during February 2013 and February 2015 was retrospectively analyzed. The patients were divided into observation group （n=38） and control group （n=31） according to different therapeutic methods. Control group received thoracic hyperthermic perfusion, while observation group was treated with bronchial arte-rial hyperthermic perfusion chemotherapy based on the treatment of control group. In two groups, clinical curative effects and toxicity and side effects of chemotherapy were evaluated;Karnofsky performance score （ KPS） was performed;levels of interleukin-10 （IL-10）, interleukin-4 （IL-4）, interleukin-2 （IL-2） and interferon gamma （IFN-γ） in pleural effusion were detected;survival rates were recorded with follow-up for 6 months. Results Values of total effective rate and 6-month survival rate in observation group were higher than those in control group （P〈0. 05）. After treatment, values of KPS, IL-2 and IFN-γlevels were significantly higher than those before treatment in two group, and the values in observa-tion group were higher than those in control group （P〈0. 05）. After treatment, IL-10 and IL-4 levels were significantly lower than those before treatment in two groups, and the levels in observation group were lower than those in control group （P〈0. 05）. After treatment, there were no significant differences in incidence rates of toxicity and side effects of chemo-therapy between two groups （P〉0. 05）. Conclusion Bronchial arterial hyperthermic perfusion chemotherapy combined with thoracic hyperthermic perfusion in treatment of patients with pulmonary malignant tumor accompanied by malignant pleural effusion can regulate Th1/Th2 unbalanced status with good short-term curative effect.