胸腔灌注姑息治疗老年云锡矿工NSCLC恶性胸腔积液的临床研究

Clinical Study of rmh TNF Combined with PDD in the Treatment of Malignant Pleural Effusion Caused by Non Small Cell Lung Cancer in the Elderly Yunnan Tin Miners

目的:评价rmh TNF(重组改构人肿瘤坏死因子)联合PDD姑息治疗老年云锡矿工非小细胞肺癌的恶性胸膜腔积液的效果及毒副反应。方法:将2014年3月-2015年6月笔者所在科室收治的39例老年云锡矿工非小细胞肺癌并恶性胸腔积液病例随机分为治疗组和对照组,排尽胸腔积液后,治疗组胸膜腔内灌注rmh TNF 100万单位加PDD 40 mg/m2;对照组胸膜腔内灌PDD 40 mg/m2。结果:治疗组总有效率为71.42%,生存时间为5~16个月,平均(8.0±4.2)个月;对照组总有效率为55.56%,生存时间为3~12个月,平均(6.0±3.7)个月,差异均有统计学意义(P<0.05);两组病例均未出现Ⅲ~Ⅳ级严重不良反应。主要不良反应有Ⅰ~Ⅱ级胸痛、发热、恶心及呕吐,发热不超过48 h,体温最高不超过38.5℃,常规对症治疗可缓解。结论:排尽积液后胸膜腔内灌注rmh TNF联合PDD姑息治疗老年云锡矿工非小细胞肺癌所致恶性胸膜腔积液有一定临床效果,不良反应可耐受,是控制积液的安全而有效的方法。

Objective：To evaluate the response and adverse reactions of rmh TNFand PDD in the treatment of malignant pleural effusion caused by non small cell lung cancer in the elderly Yunnan tin miners.Method：59 elderly Yunnan tin miners with non small cell lung cancer patients with malignant pleural effusion in the author＇s department from March 2014 to June 2015 were divided into two groups randomly.The patients in study group were treated by intracavity injection of rmh TNF with 1 millton units and PDD with 40 mg/m2,and those in the control group were treated by intracavity injection of PDD with 40 mg/m2.Result：The overall response rate of study group was 96.67%,the survival time for 5-16 months, average（8.0±4.2） months,and the control group was 82.14%, the survival time for 3-12 months, average（6.0±3.7） months,the differences were statistically significant（P〈0.05）.There were no Ⅲ-Ⅳ level serious adverse reaction cases of two groups.The main adverse reactions wereⅠ-Ⅱ chest pain, fever,nausea and vomiting,conventional symptomatic treatment can alleviate.Conclusion：After draining completely the pleural fluid,the intracavity injection of rmh TNF and PDD is more safe and effective for the treatment of malignant pleural effusion that patients with non small cell lung cancer in the elderly Yunnan tin minners.