粘质沙雷氏菌苗治疗56例恶性胸腔积液

目的：观察生物反应调节剂粘质沙雷氏菌苗治疗恶性胸腔积液的疗效。方法：56例恶性胸水患者为菌苗组，胸水引流后，注入粘质沙雷氏菌苗，另取病情相当的32例恶性胸水患者，作为对照组，注入5-氟尿嘧啶及顺铂。结果：治疗组有效率94.6%，平均起效时间9.7天。对照组有效率78.1%。平均起效时间17.2天。两者差异有显著统计学意义。治疗组主要毒副反应为发热及胸痛，无其他严重毒副反应。结论：粘质沙雷氏菌苗能有效控制恶性胸水，起效快，毒副反应小，患者生存质量提高，值得推广。     

治疗用粘质沙雷氏菌菌苗（S511）治疗癌性胸腔积液的Ⅱ期临床研究

目的 评价S311治疗癌性腔积液的疗效及毒副作用。方法 经胸穿或闭式引流抽净胸水后,胸腔注入S311 0.32mg,每周1次,连续3周,停药手观察1个月评价疗效。结果 241例患者完成胸腔注入S311治疗,总有效率92．1％,主要的不良反应为发热和胸痛,发生率分别为81．0％和52．2％,少数患者出现寒战,呼吸困难,恶心,呕吐,个别患者出现肝功能异常。结论 粘质沙雷氏菌菌苗（S311）是一种治疗癌性胸腔积液的有效药物。     

黏质沙雷氏菌苗治疗恶性胸腔积液的临床研究

目的 评价黏质沙雷氏菌苗（S311）治疗恶性胸腔积液的疗效及毒副反应。方法 取S311 10^9U(0.32mg)于第1,8,15天注入胸腔。观察4周,评价疗效和毒副反应。结果 34例患者中,完全缓解（CR）12例,部分缓解（PR）21例,总有效率97.1%(33/34)。毒副反应较轻,有发热（82．4％）、胸痛（52．9％）、恶心（26．5％）、呼吸困难（17．5％）、寒战（5．9％）及呕吐（2．9％）。结论 S311治疗恶性胸腔积液疗效较好,毒副反应可以耐受,可以安全用于临床。     

治疗用粘质沙雷氏菌菌苗（S311）治疗癌性胸腔积液的Ⅱ期临床研究

目的评价S311治疗癌性胸腔积液的疗效及毒副作用。方法经胸穿或闭式引流抽净胸水后，胸腔注入S311 0.32?mg，每周1次，连续3周，停药后观察1个月评价疗效。结果 241例患者完成胸腔注入 S311治疗，总有效率92.1％。主要的不良反应为发热和胸痛，发生率分别为81.0％和52.2％。少数患者出现寒战、呼吸困难、恶心、呕吐，个别患者出现肝功能异常。结论粘质沙雷氏菌菌苗(S311)是一种治疗癌性胸腔积液的有效药物。     

粘质沙雷氏菌苗治疗恶性胸腔积液的临床研究

目的 探讨粘质沙雷氏菌苗（S311抗癌菌苗）胸腔内注射对恶性胸腔积液患者的治疗价值。方法 前瞻性观察40例恶性胸腔积液患者胸腔内注射S311抗癌菌苗0.32-0.96mg后的疗效、不良反应及外周血免疫指标变化。结果 311抗癌菌苗胸腔内注射治疗有效率为90.0%,不良反应主要为发热（75.0%）和胸痛（15.0%）。外周血CD3^ 、CD4^ 、CD4^ ／CD8^ 未见明显增高,吞噬细胞指数明显增高,P＜0.05。75％患者Kps评分增高。结论 S311抗癌菌苗胸腔内注射对恶性胸腔积液患者有较好的疗效。     

假单胞菌苗治疗恶性胸腔积液

恶性胸腔积液是晚期胸部恶性肿瘤或胸部转移瘤常见并发症之一。过去曾应用多种方法如胸腔内注射红霉素 ,美兰 ,顺铂等 ,但疗效多不理想。我科自 1994年起应用假单胞菌苗 (ＰＴＶ)治疗恶性胸腔积液取得了较好疗效 ,现报告如下。材料和方法一、病例 :全组病人均为恶性肿瘤合并胸腔积液 ,共 58例。男 50例 ,女 8例 ,年龄 30～ 75岁 ,平均 56 .2岁 ,经病理或细胞学诊断为非小细胞肺癌 2 0例 (腺癌13例 ,鳞癌 7例 ) ,乳腺癌 2 0例 ,小细胞肺癌 10例 ,其它恶性肿瘤胸膜转移 8例 ,其中发现胸水后行全身化疗及其它方法治疗 (如红霉素等胸内注射 )效…     

假单胞菌苗治疗恶性胸腔积液：附19例疗效分析

假单胞菌苗治疗恶性胸腔积液（附１９例疗效分析）江苏省连云港市第一人民医院肿瘤内科（２２２００２）蒋芹，张为民，杨成喜我们采用济南假单胞杆菌菌苗（ＰＶＩ）治疗恶性胸腔积液，取得良好疗效。报告如下。资料与方法从１９９４年３月初至１９９４年１０月底，共观察...     

沙培林治疗肺癌所致恶性胸腔积液的临床观察

恶性胸腔积液是晚期肺癌的常见并发症之一。如何有效地控制恶性胸腔积液已成为晚期肺癌姑息性治疗的重要组成部分。1998年4月-1999年2月,我院内科采用胸腔内注射沙培林的方法治疗晚期肺癌所致的恶性胸腔积液26例,取得了较为满意的效果,现总结报告如下。1　材料与方法1.1　病例选择　本组26例中,男性18例,女性8例,年龄41岁～68岁。所有病例均经病理和/或细胞学确诊。24例患者在治疗前均有程度不等的胸闷、气短、咳嗽等压迫症状。在病理分类中,肺腺癌22例,未分化或低分化癌3例,鳞癌1例。合并对侧胸腔积液者2例(少量),心包积液者4例,肝转移者3…     

济南假单胞菌苗注射液治疗恶性胸腔积液的III期临床观察

１９９３年４月－１９９４年９月间，作者用济南假南胞菌苗注射液（商品名佳代胞，简称ＰＶＩ）胸腔内注射治疗恶性胸膜腔积液，并进行了前瞻性多中心研究。     

胸腔镜在恶性胸腔积液诊断和治疗上的应用

目的　探讨胸腔镜在恶性胸腔积液诊断和治疗上的价值。方法　对15例原因不明的胸腔积液患者作胸腔镜检查,并经胸腔镜喷入滑石粉及顺铂治疗。结果　所有病例经胸腔镜行活检均确诊为恶性病变,总诊断率为100%。经滑石粉喷入和顺铂局部治疗后14例获得完全的胸膜固定,持久的成功率为93.3%。结论　胸腔镜对胸腔积液病因诊断有较高临床实用价值,滑石粉胸膜固定加顺铂治疗是控制恶性胸腔积液、治疗晚期癌症的一种有效方法。     

Preliminary results of a new small-bore percutaneous pleural catheter used for treatment of malignant pleural effusions in ECOG PS 3-4 patients

Background

In cancer patients with malignant pleural effusions(MPEs),the commonest procedure to treat them with palliative intention is talc pleurodesis (TP) which can be obtained with talc slurry (TS) using small-bore catheters(SBC)or with thoracoscopic poudrage. SBC use is therefore rapidly increasing. The aim of this paper is to present our preliminary TP results using a new percutaneous chest drainage system(UNICO^®,Redax,Mirandola Modena, Italy).

Methods

In the period 1st March-20th of July 2011,seven consecutive ECOG PS 3-4 patients(4 females, mean age 73.2 ± 12.1 years),unfit for thoracoscopic talc poudrage, were enrolled in our study. All patients received many thoracentesis before the placement of a chest drainage(median thoracentesis number:4.42 ± 1.13).UNICO^® was bedside placed in all cases and TS was administered through the drainage when the overall fluid amount didn’t exceed 150-200 ml/24 h and the lung was correctly re-expanded at the chest X-ray control.

Results

There were no clinical complications following the placement of the drainage: its placement was easy, safe and well-tolerated by all patients. The median chest tube stay, before TS, was 7.2 ± 2.7 days while the median chest tube stay after TS was 1.5 ± 0.7 days. A satisfactory radiological lung expansion was achieved in all cases; PL effectiveness and dyspnea relief were complete in 6 and 4 cases, respectively. No patients required any further thoracentesis.

Conclusions

TS through UNICO^® is safe and efficient. The drainage was well-tolerated by all patients, even in case of its long-term stay. We may conclude that bedside TS through this new small-bore percutaneous drainage should be proposed as a viable clinical solution for MPEs in ECOG PS 3-4 patients, unfit for a thoracoscopic procedure. Moreover, with this device, we believe that TS might be an accessible procedure for pulmonologists and oncologists too.     

Altered CD94/NKG2A and perforin expression reduce the cytotoxic activity in malignant pleural effusions

CD94/NKG2A is an inhibitory receptor expressed by NK cells and cytotoxic lymphocytes and, upon activation by HLA-E, downregulates the cytolytic activities of these cells thus representing a tumour immune escape mechanism.This study was aimed at assessing whether cytotoxic lymphocytes (CD8+) and NK cells from malignant pleural effusions have a deregulated expression of CD94/NKG2A.The expression of membrane CD94/NKG2A and perforin was evaluated by flow-cytometry in CD8+ and NK cells from pleural effusions and autologous peripheral blood of cancer (n = 19) and congestive heart failure (CHF) (n = 11) patients. Intracellular CD94/NKG2A expression was evaluated by flow-cytometry in pleural effusion CD8+ and NK cells from cancer patients (n = 10). Cytotoxic activity against cancer cells exerted by pleural and autologous peripheral blood T lymphocytes from cancer patients was assessed by flow-cytometry assay.Pleural CD8+ from cancer patients showed a reduced expression of membrane CD94/NKG2A and perforin when compared to autologous peripheral blood and CHF pleural effusions. Reduced numbers of NK cells were present in pleural effusions from both cancer and CHF patients. Pleural NK from cancer patients showed a reduced expression of membrane CD94/NKG2A and perforin when compared to autologous peripheral blood. Pleural T lymphocytes from cancer patients exhibited a reduced cytotoxic activity against cancer cells when compared to autologous peripheral blood T lymphocytes. The intracellular expression of CD94/NKG2A in CD8+ and NK cells from cancer patients was higher than membrane expression.In conclusion, this study provides compelling evidences of new mechanisms underlying the reduced host defence against cancer within the pleural space.     

从恶性胸腔积液体外诱导成熟树突细胞

背景与目的:树突细胞(dendriticcells,DCs)具有激活初始T细胞、引发抗原特异性免疫反应的特性。本研究拟用体外培养的方法,从肺癌患者恶性胸腔积液中诱导出功能健全的DCs。方法:取16例肺癌患者胸腔积液500～1000ml,用密度梯度离心辅以免疫磁珠分选的方法,分离出DCs前体细胞,加入IL鄄4、GM鄄CSF、TNF鄄α诱导出DCs。用电镜和光镜观察培养的DCs,用流式细胞仪检测DCs的表面分子。将不同培养时间的DCs和肿瘤浸润性淋巴细胞(tumorinfiltrativelymphocytes,TILs)作混合淋巴细胞反应,了解DCs对TILs的激活作用。结果:在体外能诱导出恶性胸腔积液来源的功能健全的DCs,电镜和光镜分析表明,这类DCs具有成熟DCs的典型形态;当DCs体外培养到第48h时,表面分子的表达率与培养0h、24h、92h、192h的DCs比较相对较高;DCs可使TILs细胞扩增。结论:可从肺癌患者恶性胸腔积液中诱导具有成熟功能的DCs。     

Home-management of malignant pleural effusion with an indwelling pleural catheter: Ten years experience

Background

More than one half of patients with cancer have a malignant pleural effusion (MPE) at some time during their life span. Recurrent malignant pleural effusions impair respiratory functions and worsen the quality of life. Once a patient develops MPE, only fluid drainage relieves pulmonary compression and dyspnea. Optimal treatment is however, still controversial. In patients not suitable for pleurodesis, or with recurrent MPE after pleurodesis, or with trapped lung, the outpatient intermittent drainage through a subcutaneous tunneled indwelling pleural catheter (IPC) is a possible choice.

Methods

In ten years, we treated 90 patients by outpatient insertion of IPC. Eligibility for IPC required previous thoracentesis with histological confirmation of malignancy and chest roentgenogram evidence of effusion. All patients treated were made aware of their malignancy and positive cytology in the pleural effusion.

Results

Mean survival was 197 days (range 23–296 days). Median time of draining interval was 7.0 days with maximum amount of effusion drained off being 1000 ml. Pleurodesis occurred in 37 (41.1%) patients with a mean time of pleurodesis of 51 days (range 34–78 days). No major complication was recorded.

Conclusions

The IPC is a useful device in the management of recurrent MPE. Treatment can be entirely accomplished at home and the complication rate is low.     

流式细胞仪DNA倍体分析用于良恶性胸腔积液的鉴别诊断

流式细胞术是近年来应用较广泛的一种现代细胞分析技术.研究显示,流式细胞术DNA倍体分析可以在92%的实体肿瘤上检测到DNA异倍体的存在.因此也被用到了恶性胸腔积液的诊断中.本文回顾了现有流式细胞术DNA倍体分析用于恶性胸腔积液诊断的研究,评估其临床可行性.     

单操作孔胸腔镜胸膜固定术治疗恶性胸腔积液

目的 观察恶性胸腔积液的微创治疗效果.方法 回顾性分析经单操作孔胸腔镜胸膜固定术治疗的24例恶性胸腔积液患者的临床资料.结果 所有病例无围术期死亡;手术时间为32～83 min,平均34.5 min;术后拔管时间4～15d,平均5.6 d;术后全部患者1、3、6、12个月复查胸部CT,随访1 ～12个月,未见胸腔积液复发;24例患者中,1例术后5个月死于脑转移,余23例患者生存期均超过6个月.结论 单操作孔胸腔镜胸膜固定术是治疗恶性胸腔积液微创、有效的治疗手段.     

Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions

Carcinoembryonic antigen (CEA), carbohydrate antigens 15-3, 19-9 and 72-4 (CA 15-3, CA 19-9 and CA 72-4), cytokeratin 19 fragments (CYFRA 21-1), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC) were evaluated in pleural fluid for the diagnosis of malignant effusions. With a specificity of 99%, determined in a series of 121 benign effusions, the best individual diagnostic sensitivities in the whole series of 215 malignant effusions or in the subgroup of adenocarcinomas were observed with CEA, CA 15-3 and CA 72-4. As expected, a high sensitivity was obtained with SCC in squamous cell carcinomas and with NSE in small-cell lung carcinomas. CYFRA and/or CA 15-3 were frequently increased in mesotheliomas. Discriminant analysis showed that the optimal combination for diagnosis of non-lymphomatous malignant effusions was CEA + CA 15-3 + CYFRA + NSE: sensitivity of 94.4% with an overall specificity of 95%. In malignant effusions with a negative cytology, 83.9% were diagnosed using this association. The association CYFRA + NSE + SCC was able to discriminate adenocarcinomas from small-cell lung cancers. Regarding their sensitivity and their complementarity, CEA, CA 15-3, CYFRA 21-1, NSE and SCC appear to be very useful to improve the diagnosis of malignant pleural effusions.     

力尔凡治疗恶性胸腔积液的临床研究

目的：观察力尔凡治疗恶性胸腔积液的疗效及副作用。方法：对60例恶性胸腔积液患者引流尽胸腔积液后，腔内注入力尔凡30mg，B超检查，观察效果。结果：控制胸腔积液cR18例，PR27例，有效率达75％。不良反应主要是胸痛和发热。结论：力尔凡能有效控制胸腔积液，提高患者的生活质量，是治疗恶性胸腔积液的有效药物之一。     

VEGF及Angiopoietin-2对恶性胸腔积液的诊断价值

目的：探讨检测血管内皮生长因子（vascular endothelial growth factor,VEGF）及血管生成素-2（An—giopoietin-2,Ang-2）对恶性胸腔积液的诊断价值。方法：选择恶性胸腔积液患者31例,良性胸腔积液3例,（Roc）曲线计算上述指标的诊断敏感度、特异度及ROC曲线下面积。并对VEGF及Ang-2之间的相关性进行分析。结果：恶I生胸腔积液中的VEGF及Ang-2含量（1106±555vs527±229,19．26±6．39VS12．25±7．1）明显高于良性胸腔积液（P〈0．05）;VEGF诊断恶性胸腔积液的敏感度及特异度分别是：82％和90％,Ang-2诊断的敏感度及特异度分别是：65％和71％;恶性胸腔积液中Ang-2的含量与VEGF的含量呈正相关。结论：VEGF及Ang-2可作为恶性胸腔积液诊断的良好指标,可指导选择对患者进行进-步的侵入性检查。