胸腔温热灌注化疗在晚期胸腺肿瘤胸膜切除术中的应用

Application of Hyperthermic Intrapleural Chemotherapy in Pleurectomy for Patients with Advanced Thymoma

目的探讨胸膜切除术联合胸腔温热灌注化疗治疗Ⅳa期胸腺肿瘤的效果及手术配合,以期改善局部晚期胸腺肿瘤患者的治疗效果和生活质量。方法回顾性分析2015年2月至2016年4月在上海胸科医院行胸膜切除术联合胸腔温热灌注化疗治疗的11例胸膜转移Ⅳa期胸腺肿瘤患者的临床资料,观察其治疗效果,总结手术护理配合要点。结果 11例患者手术均顺利完成,术后恢复良好,无院内死亡。1例患者术中因灌注侧肺不能很好萎陷而取消胸腔温热灌注化疗。10例完成胸腔温热灌注化疗的患者灌注前后鼻咽温度升高,差异有统计学意义(P<0.05);心率、血压、中心静脉压、血氧饱和度的变化差异均无统计学意义(均P>0.05);术后复查肝肾功能未见异常,但外周血白细胞较术前增高,差异有统计学意义(P<0.05);术后6个月复查CT,10例行胸腔温热灌注化疗患者均没有出现胸膜局部复发病灶,仅有1例患者出现颈部淋巴结转移。结论应用胸膜切除联合胸腔温热灌注化疗治疗胸膜转移的Ⅳa胸腺肿瘤安全有效。充分的术前准备、术中精准的温度管理及无菌无瘤技术的执行是治疗成功的关键。

Objective To evaluate the efficacy of pleurectomy combined with hyperthermic intrapleural chemotherapy in the treatment of advanced thymoma,in order to achieve the optimal treatment effect for patients and improve their quality of life. Methods Clinical data of 11 patients with clinical diagnosis of stage IVa thymoma received pleurectomy and hyperthermic intrapleural chemotherapy in Shanghai Chest Hospital were analyzed retrospectively.Results 11 patients received pleurectomy successfully and recov- ered well,with no hospital death. 1 patient failed to receive hyperthermic intrapleural chemotherapy due to the unsatisfied one-lung ventilation.The other 10 patients phase after hyperthermic intrapleural chemotherapy had significantly higher nasopharyngeal temperature in postoperative than preoperative phase （P〈0.05）, without significant in change of heart rate,blood pressure,central venous pressure and oxygen saturation（all P〈0.05） ;postoperative liver and kidney function was normal,but peripheral leucocytes cell counts were more than that in preoperative stage （P〈0.05）.All patients received CT scan at 6 months after operation,and no recurrent lesions were found on the pleura, with only 1 case of cervical lymph node metastasis.Conclusion Pleurectomy combined with hyperthermic intrapleural chemotherapy is a safe and effective treatment for patients with IVa thymoma or thymic carcinoma.Sufficient preparations before operation,accurate temperature management and the implementation of aseptic technique are the keys to the success of this treatment.