胸部肿瘤切除术中同期行体外循环辅助胸腔热灌注化疗的临床应用

Clinical application of extracorporeal circulatory concurrent assisted thoracic hyperthermia chemotherapy perfusion during thoracic tumor resection

目的探讨体外循环(ECC)辅助热灌注化疗在胸部肿瘤合并胸腔恶性积液的短期疗效。方法回顾自2012年12月至2022年12月,本中心15例胸部肿瘤切除后术中同期行ECC辅助胸腔热灌注化疗的临床病例,探讨其短期疗效及安全性问题。结果15例患者短期疗效显著,其胸腔积液短期客观缓解率达100%;患者的氧合指数治疗后第3天[(382±53)mmHg vs.(317±86)mmHg,P=0.019]及治疗后第4周(442±55)mmHg vs.(317±86)mmHg,P<0.001]与治疗前比较均有改善,差异具有统计学意义。患者血白细胞[(8.1±1.97)×10^(9)/L vs.(6.06±1.25)×10^(9)/L,P=0.003]、尿素氮[(6.3±1.6)mmol/L vs.(5.1±1.2)mmol/L,P=0.027]及天冬氨酸基转移酶[(29±9)U/L vs.(20±12)U/L,P=0.028]在治疗后较治疗前有所上升;血小板[(117±12)×10^(9)/L vs.(125±14)×10^(9)/L,P=0.002]、凝血酶原时间[(12±1.0)s vs.(13.2±1.3)s,P=0.005]、活化部分凝血活酶时间[(25.9±3.6)s vs.(31.8±8.1)s,P=0.015]较治疗前下降,但均在正常范围内。结论术中同期行ECC辅助胸腔热灌注化疗安全可行,其胸腔积液短期客观缓解率高,临床上值得推广。

Objective To investigate the short-term efficacy of extracorporeal circulatory(ECC)hyperthermia chemotherapy in patients with thoracic tumor complicated with malignant pleural effusion.Methods From December 2012 to December 2022,15 clinical cases who received ECC hyperthermia chemotherapy during surgery in our center were reviewed to discuss the short-term efficacy and safety.Results 15 patients who received ECC hyperthermia chemotherapy during surgery had significant short-term efficacy,and the short-term objective remission rate of pleural effusion reached 100%.At day 3 and 4 weeks after treatment,the oxygenation index of the patients was improved significantly compared to that before treatment,the difference was statistically significant(382±53 mmHg vs.317±86 mmHg,P=0.019;442±55 mmHg vs.317±86 mmHg,P<0.001).In security,white blood cells(8.1±1.97×10^(9)/L vs.6.06±1.25×10^(9)/L,P=0.003),urea nitrogen(6.3±1.6 mmo1/L vs.5.1±1.2mmo1/L,P=0.027)and aspartic transferase(29±9 U/L vs.20±12 U/L,P=0.028)increased after treatment,while platelet(117±12×10^(9)/L vs.125±14×10^(9)/L,P=0.002),prothrombin time(12±1.0 s vs.13.2±1.3 s,P=0.005),and activated partial thrombin time(25.9±3.6 s vs.31.8±8.1 s,P=0.015)decreased after treatment,but they're all within normal limits.Conclusion ECC hyperthermia chemotherapy is safe and feasible,and its short-term objective remission rate is high,which is worth promoting clinically.