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1、射频透热与化疗综合治疗恶性体腔积液410013长沙中南大学湘雅三医院肿瘤科曹培国,张隽,唐又群,姚志平,张震,符慧群,潘宇亮【摘要】目的评价热化综合治疗恶性体腔积液的疗效、毒副反应及对生活质量的影响。方法86例病人均是经过手术、放射治疗和(或)多程化疗后复发及广泛转移的患者,其中胸水49例,心包积液3例,腹水50例;先行穿刺引流并以单药或二联化疗药物行腔内注射,常用药物为DDP(顺铂)50~100mg,MMC(丝裂霉素)8~10mg,5-Fu(氟脲嘧啶)1.0~1.5g,THP-ADM(吡喃阿霉素)40mg,腔内化疗1~6次,平均3次;患者一般情况改善后行全身化疗,根据不同病种选择不同
2、用药方案;每次腔内及静脉化疗后即行射频透热,2次/周,平均6次,腔内温度控制在42℃左右并维持40~60min。结果49例胸水CR26例,PR17例,有效率87%;3例心包积液均CR;50例腹水CR24例,PR14例,有效率76%;不同病种有效率不同,以乳腺、肺、卵巢及胃肠道肿瘤并积液者疗效较好。治疗后Karnofsky评分80~100组由0%上升到28%,60~70组由23%上升到43%,0~30组治疗前后无明显变化。与热疗相关的主要副反应为局部皮肤疼痛(17%)和皮下脂肪硬结(11%)。结论热化综合治疗恶性体腔积液有较好疗效,并可明显改善患者生活质量,毒副反应可耐受。【关键词】恶性
3、胸腔积液;恶性心包积液;腹水;热疗;化疗;生活质量9TreatmentofmalignantpleuralorpericardialeffusionandascitesusinghyperthermiacombinedwithchemotherapyCAOPei-guo,ZHANGJun,TANGYou-qun,etal.DepartmentofOncology,TheThirdXiangyaHospital,CentralSouthUniversity,Changsha410013,China【Abstract】Objective:Toevaluatetheefficacyandto
4、leranceofhyperthermiacombinedwithchemotherapyintreatmentofmalignantpleuralorpericardialeffusionandascites.Methods:All86caseswererecurrentormetastaticcancerpatients.49caseshadmalignantpleuraleffusion,3caseshadmalignantpericardialeffusionand40caseshadascites.Afterdrainage,oneortwochemotherapeuticd
5、rugssuchasDDP50~100mg,MMC8~10mg,5-Fu1.0~1.5gorTHP-ADM40mgwereinjectedintothepleural,pericardialorperitonealcavity.Bythetimethepatient’ssymptomssuchasdysponeaorabdominaldistentionrelief,systemchemotherapybegan.Eachtimechemotherapywasfollowedbyhyperthermiawhichmaintainedthecavity’stemperatureat42℃
6、for40~60minutes.Hyperthermiawasperformedtwiceperweekfor3~4weeks(6timesatmeans).Then,theefficacy,qualityoflifeandtoxicitieswereevaluated.Results:Theresponseratewas87%in49caseswithmalignantpleuraleffusionand76%in50caseswithascitesand100%in3caseswithmalignantpericardialeffusion.Theresponseratewasbe
7、tterinbreast,lung,ovariananddigestivetractcancerpatientswithmalignantpleuraleffusionorascites.Aftercombinedtreatment,theKarnofskyscoresrisedfrom0%to28%at80~100groupandfrom23%to43%at60~70group,buttherewasnodifferenceat0~30gro