滑石粉联合顺铂治疗恶性胸腔积液的临床观察
摘要
目的 观察滑石粉联合顺铂胸腔内灌注治疗恶性胸腔积液的疗效及毒副反应。
方法 将33例恶性胸腔积液患者随机分为2组，滑石粉联合顺铂治疗组(治疗组)15例，顺铂治疗组(对照组)18例，所有患者均采用中心静脉导管进行胸腔闭式引流，待胸腔积液引流彻底后给予胸腔内给药，滑石粉联合顺铂治疗组：给予生理盐水30ml+滑石粉3～4g，半小时后再给予生理盐水30ml+顺铂60mg。顺铂治疗组：给予生理盐水30ml+顺铂60mg。注药后夹管并嘱患者变换体位，6小时后重新放开引流，待引流液体量每日少于50～100ml则考虑拔管。随后，每2周复查胸片或B超，2个月后观察比较两组胸腔积液量的变化、呼吸困难等症状改善、Karnofsky(KPS)标准评分变化和毒副反应。
结果 2月后结果显示：滑石粉联合顺铂组：完全缓解(CR)10例，部分缓解(PR)4例，无效(NR)1例，总有效率(CR+PR)93.3％；顺铂组：CR 2例，PR 9例，NR 7例，总有效率(CR+PR)61.1％，滑石粉联合顺铂组优于顺铂组，两组疗效比较有显著差异(P＜0.05)。患者呼吸困难等症状明显改善。治疗组KPS评分由60.00±5.35提高到76.00±5.07，对照组KPS评分由61.67±5.15提高到65.56±7.84，两组比较有显著性差异(P＜0.05)。主要毒副反应为胸痛、发热、恶心、呕吐等，治疗组比对照组胸痛、发热发生率更高(P＜0.05)，所有患者均未发生严重的并发症。
结论 滑石粉联合顺铂治疗恶性胸腔积液是一种安全有效的治疗手段，能有效控制胸腔积液，缓解呼吸困难等症状，改善体力状况，提高生活质量，无明显毒副作用。
Objective: To observe the efficacy and toxicity of the talc combined with DDP in the treatment of malignant pleural effusion(MPE).
Methods: 33 cases of pleural effusion were divided randomly.into two groups , the talc combined with DDP group( treament group) and DDP group( control group).There were 15 patients in the talc combined with DDP group,the other were 18 patients in DDP group. A chest drain(central venous catheter) was inserted in all patients.The adminisatration was performed when the chest cavity was drained as completely as possible. The talc combined with DDP group: 3 to 4 grams of asbestos-free talc were suspended 30ml of saline solution(0.9%) injected via the chest tube drain into the pleural space, after an addition 30 minutes,DDP60mg mixed with 30ml of saline solution(0.9%) were injected though the chest tube too.DDP group: DDP60mg mixed with 30ml of saline solution(0.9%)were injected via the chest tube drain into the pleural space .All patients were asked to change their position every 5 to 10 minutes to allow adequate distribution .The drains was then clamped , the chest tube was then unclamped after 6 hours, the chest cavity was drained again.The 24-hours output from the chest tube is less than 50 to 100ml, the intercostals drain was removed.In the two months after trentment, chest radiograph or B-ultrasomotonography were used to evaluated the conditions of the patients every 2 weeks. The comparison was made on MPE and dyspnea between two groups, changes of Karnofsky performance status score and toxicity before and after each of these two treatments.
Results:when the patients have been treated for two months, chest radiograph or B-ultrasomotonography were repeated in them.The results showed:the talc Combin
方法 将33例恶性胸腔积液患者随机分为2组，滑石粉联合顺铂治疗组(治疗组)15例，顺铂治疗组(对照组)18例，所有患者均采用中心静脉导管进行胸腔闭式引流，待胸腔积液引流彻底后给予胸腔内给药，滑石粉联合顺铂治疗组：给予生理盐水30ml+滑石粉3～4g，半小时后再给予生理盐水30ml+顺铂60mg。顺铂治疗组：给予生理盐水30ml+顺铂60mg。注药后夹管并嘱患者变换体位，6小时后重新放开引流，待引流液体量每日少于50～100ml则考虑拔管。随后，每2周复查胸片或B超，2个月后观察比较两组胸腔积液量的变化、呼吸困难等症状改善、Karnofsky(KPS)标准评分变化和毒副反应。
结果 2月后结果显示：滑石粉联合顺铂组：完全缓解(CR)10例，部分缓解(PR)4例，无效(NR)1例，总有效率(CR+PR)93.3％；顺铂组：CR 2例，PR 9例，NR 7例，总有效率(CR+PR)61.1％，滑石粉联合顺铂组优于顺铂组，两组疗效比较有显著差异(P＜0.05)。患者呼吸困难等症状明显改善。治疗组KPS评分由60.00±5.35提高到76.00±5.07，对照组KPS评分由61.67±5.15提高到65.56±7.84，两组比较有显著性差异(P＜0.05)。主要毒副反应为胸痛、发热、恶心、呕吐等，治疗组比对照组胸痛、发热发生率更高(P＜0.05)，所有患者均未发生严重的并发症。
结论 滑石粉联合顺铂治疗恶性胸腔积液是一种安全有效的治疗手段，能有效控制胸腔积液，缓解呼吸困难等症状，改善体力状况，提高生活质量，无明显毒副作用。
Objective: To observe the efficacy and toxicity of the talc combined with DDP in the treatment of malignant pleural effusion(MPE).
Methods: 33 cases of pleural effusion were divided randomly.into two groups , the talc combined with DDP group( treament group) and DDP group( control group).There were 15 patients in the talc combined with DDP group,the other were 18 patients in DDP group. A chest drain(central venous catheter) was inserted in all patients.The adminisatration was performed when the chest cavity was drained as completely as possible. The talc combined with DDP group: 3 to 4 grams of asbestos-free talc were suspended 30ml of saline solution(0.9%) injected via the chest tube drain into the pleural space, after an addition 30 minutes,DDP60mg mixed with 30ml of saline solution(0.9%) were injected though the chest tube too.DDP group: DDP60mg mixed with 30ml of saline solution(0.9%)were injected via the chest tube drain into the pleural space .All patients were asked to change their position every 5 to 10 minutes to allow adequate distribution .The drains was then clamped , the chest tube was then unclamped after 6 hours, the chest cavity was drained again.The 24-hours output from the chest tube is less than 50 to 100ml, the intercostals drain was removed.In the two months after trentment, chest radiograph or B-ultrasomotonography were used to evaluated the conditions of the patients every 2 weeks. The comparison was made on MPE and dyspnea between two groups, changes of Karnofsky performance status score and toxicity before and after each of these two treatments.
Results:when the patients have been treated for two months, chest radiograph or B-ultrasomotonography were repeated in them.The results showed:the talc Combin
引文
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7. Genc O, Petrou M, Ladas G, et al. The longterm morbidity pleuroperiton -eal shunts in the management of recurrent malignant effusions. Eur J Cardiothorac Surg, 2000,18 (2) :143-146
8. Ukale V, Agrenius V, Hillerdal G, et al. Pleurodesis in recurrent pleural effusions:a randomized comparison of a classical and a currently popular drug. Lung Cancer, 2004,43(3) 323-328
9. Tan C, Sedrakyan A, Browne J, et al. the evidence on the effectiveness of management for malignant pleural, effusion: a systematic review. Eur J Cardiothorac Surg.,2006,29(5):829-838.
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20. Chambers JS. Palliative treatment of neoplasic pleural effusion with intercostals intubation and talc in stillation. WestJ Surg, 1958, 66:26-31
21. Glazer M, Berkman N, Lafair JS, et al. successful talc slurry pleurodesis in patient with nonmalignant pleural effusion:Report of 16 cases and review of the literature. Chest, 2000,117:1404-1409
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2．叶任高，陆再英主编．内科学．人民卫生出版社．第6版．2004：110
3. Woff AB, Silen ML, Kokoska ER, et al. Treatment of refractory chylothl -orax with externalized pleuroperitoneal shunts in children. Ann Thorac Surg, 1999,68:1053-1057
4. Saha SA. Management of malignant pleural effusions. Monaldi Arch Chest Dis,2001,56(5):394-399.
5．赵凤瑞，赵莹昕．胸腹腔分流术治疗顽固性胸液．中华结核和呼吸杂志．1998，21：117-118
6. Schulze M, Boehle AS, Kurdow R, et al. Effective treatment of malignant pleural effusionby minimal invasive thoracic surgery: thoracoscopic talc pleurodesis and pleuroperitoneal shunts in 101 patients. Ann Thorac Surg, 2001, 71(6):1809-1812.
7. Genc O, Petrou M, Ladas G, et al. The longterm morbidity pleuroperiton -eal shunts in the management of recurrent malignant effusions. Eur J Cardiothorac Surg, 2000,18 (2) :143-146
8. Ukale V, Agrenius V, Hillerdal G, et al. Pleurodesis in recurrent pleural effusions:a randomized comparison of a classical and a currently popular drug. Lung Cancer, 2004,43(3) 323-328
9. Tan C, Sedrakyan A, Browne J, et al. the evidence on the effectiveness of management for malignant pleural, effusion: a systematic review. Eur J Cardiothorac Surg.,2006,29(5):829-838.
10．李丽．双途径化疗治疗恶性腔内积液9例报告．实用肿瘤杂志．1991，5(3)：41
11. Brega-Massone PP, Lequaglie C, Magnani B, et al. Chemical pleurodesis to improve patients' quality of life in the management of malignant pleural effusions:the 15 year experience of the national Cancer Institute of Milan. Surg Laparosc Endosc Percutan Tech, 2004, 14(2):73-79
12. Kilic D, Akay H, Kavukcu S, et al. Management of recurrent malignant pleural effusion with chemical pleurodesis. Surg Today, 2005,35(8) :634
13. Barbetakis N, Antoniadis T,T silikasc, et al. Results of chemical pleurodesis. with mitoxantrone in malignant pleural effusion from breast cancer. World J Surg Oncol, 2004,20;2(1):6
14．孙燕主编．内科肿瘤学．第1版．北京：人民卫生出版社，2003，995-997
15．李振，许德顺，王化州，等．恶性肿瘤的化学治疗与免疫治疗．北京人民卫生出版社．1993：63
16．张敦华．胸膜固定术硬化剂的应用和机制．中华结核和呼吸杂志．2001，24(1)：21-22
17 刘丹，李三焕．闭式引流并注入顺铂治疗癌性胸水．实用癌症杂志．1993，8(2)：120
18. Weatherhead M, Antunes G. Chemotherapeutic management of malignant pleural effusion. Epert Opin Pharmacother, 2004,5(6):1233-1242
19. Bethune N. Pleural poudrage:newtechniques for deliberate production of pleural adhesions as preliminary to lobectomy. J Thorac Surg, 1935,4:251-261
20. Chambers JS. Palliative treatment of neoplasic pleural effusion with intercostals intubation and talc in stillation. WestJ Surg, 1958, 66:26-31
21. Glazer M, Berkman N, Lafair JS, et al. successful talc slurry pleurodesis in patient with nonmalignant pleural effusion:Report of 16 cases and review of the literature. Chest, 2000,117:1404-1409
22．张兴善主翻译．复发性恶性胸水的治疗．实用医学杂志．1995,11(19)：641—642
23. Haddad FJ, Younes RN, Gross JL, et al. Pleurodesis in patients with malignant pleural effusions: talc slurry or bleomycin? Results of a prospective randomized trial. World J Surg, 2004, 28(8):749-753
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