多西紫杉醇胸腔灌注化学疗法治疗恶性胸腔积液的临床疗效观察

Clinical efficacy of pleural infusion chemotherapy with docetaxel in treating malignant pleural effusion

目的探讨多西紫杉醇胸腔灌注化学疗法(化疗)治疗恶性胸腔积液的有效性及安全性。方法选取2013年3月-2014年6月经活体组织检查或术后病理确诊为恶性肿瘤且合并胸腔积液患者23例(经胸腔积液脱落细胞学检查均证实为恶性胸腔积液),予胸腔穿刺置管引流,待胸腔积液基本排净后,排除化疗禁忌,给予多西紫杉醇40 mg/m^2+生理盐水250 mL+地塞米松10 mg胸腔内灌注化疗,每21天为1个周期,其中灌注前需行多西紫杉醇用药前标准预处理防治过敏及体液潴留不良反应(地塞米松、西米替丁或雷尼替丁、异丙嗪),每个周期评估疗效及安全性。结果 23例入选患者中,6例患者疗效评价为完全缓解,11例患者疗效评价为部分缓解,有效率达73.91%;患者可耐受,不良反应主要为骨髓抑制(78.26%)及恶心、呕吐(82.61%)。所有患者均未见过敏、体液潴留、心脏毒性不良反应,以及Ⅳ度不良反应。结论多西紫杉醇胸腔灌注化疗治疗恶性胸腔积液疗效确切,不良反应轻,值得临床推广。

Objective To evaluate the clinical efficacy and safety of pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion.Methods Twenty-three patients with malignant tumor confirmed by biopsy or postoperative pathology,complicated with malignant pleural effusion confirmed by exfoliative cytology,were treated between March 2013 and June 2014.All the 23 patients underwent thoracic puncture and catheter drainage for the removal of contraindications for chemotherapy.Then,pleural infusion chemotherapy was performed with docetaxel（40 mg/m^2）,normal saline（250 mL） and dexamethasone（10 mg）,21 days as a cycle.Before pleural infusion chemotherapy with docetaxel,all the patients were given standard pretreatment with dexamethasone,cimetidine/ranitidine or promethazine.The efficacy and safety of the treatment were evaluated in each cycle.Results Among the 23 selected patients,6 were evaluated as complete remission and 11 as partial remission,with an effective rate of 73.91%.All the patients had acceptable tolerance in the process of the treatment.The most common side effects were bone marrow suppression（78.26%）,and nausea and vomiting（82.61%）.No such complications as allergy,fluid retention,cardiac toxicity or degree-adverse reactions were detected.Conclusion Pleural infusion chemotherapy with docetaxel in the treatment of malignant pleural effusion is effective with mild adverse reactions,which is worthy to be popularized.