不同药物局部治疗96例癌性胸腔积液的疗效观察

Effects of intrapleural therapy on 96 patients with malignant pleural effusion

目的 探讨应用免疫生物制剂和抗癌药物对癌性胸腔积液的局部治疗效果。方法 将 96例中等量以上胸腔积液患者分为四组采用不同药物进行治疗。 ( 1)A组 :3 4例 ,用短小棒状杆菌 (CP)治疗 ;( 2 )B组 :3 1例 ,用沙培林 (OK 43 2 )治疗 ;( 3 )C组 :10例 ,用罗扰素治疗 ;( 4 )D组 :2 1例 ,用抗癌化学药物治疗。全部患者均在胸腔穿刺抽液或胸腔插管闭式引流完胸腔内液体后注入药物。结果 A组的有效率为 91.2 % ,B组为 83 .9% ,C组为 80 % ,D组为 80 .9% ,其中完全缓解率依次为 3 5 .3 % ,2 5 .8% ,10 .0 % ,和 9.5 % ,A组优于D组 (P <0 .0 5 )。四组病人治疗后的生存质量KPS评分均较治疗前明显改善 (P <0 .0 0 1) ,以CP组改善最为明显 (P <0 .0 5 )。局部注入药物后均可引起不同程度的发热 ,胸痛和消化道症状。结论 胸腔穿刺抽流和胸腔插管闭式引流后胸腔内局部注入免疫生物制剂和抗癌药物对恶性胸腔积液是一种可取有效的局部治疗方法。结合患者的生活质量改善分析 。

Objective To explore the effectiveness of immuno-biologicals and anticarcinogen to malignant pleural effusion.Methods 96 cases with malignant pleural effusion (male 49,female 47,average age is 56.4 yrs) were divided into 4 group which was treated by injection of different medication, i.e.Group A (34 cases) with Corynebacterium Parvum(CP),group B(31cases) with OK-432,group C (10cases) with interferon(IFN)(-2a and group D (21cases) with anticarcinogen.The drugs were intrapleural therapy after needle thoracocentesis or thoracic closed drainage.Results Effective rates of the 4 groups were 91.2%,83.9%,80%,80.9%,respectively.And the completely remission rates were 35.3%,25.8%,10.0% and 9.5%,respectively.The rates of group A was better than group D(P< 0.05).The effect of thoracic puncture was better than closed drainage.(P<0.01).The KPS improved after the treatment than before(P<0.001),and that of group A was the best(P<0.05).The side effects included fever,chest pain and digestive disorder.Conclusions Local injection of immuno-biologicals and anticarcinogen a after drainage of the effusion are effective therapy to malignant pleural methods.Based on the improvement of life quality,CP is better than the others.