胸腔内循环高温灌注化疗对恶性胸腔积液的作用

目的:总结胸腔内循环高温灌注化学治疗对恶性胸腔积液的作用及优点。方法:对40例恶性胸腔积液的患者,在全身麻醉胸腔镜下用体外循环机将43℃恒温液(生理盐水3000mL、顺铂300mg)持续灌注胸腔1h。结果:患者胸闷、气急等症状消失,胸水控制,KPS评分均在70分以上,毒副作用能耐受。胸水中CEA、CYFRA21-1、NSE浓度较治疗前明显下降(P<0.05),镜下观察胸膜癌结节中癌细胞大量坏死,电镜下可见染色质浓缩、凋亡小体形成,最终核碎裂、肿瘤细胞死亡。结论:胸腔内循环高温灌注化疗对恶性胸腔积液有较好的治疗作用,不良反应轻微,微创,对年老体弱患者也适用。

Effect of Intrapleural Circular Hyperthermic Perfusion Chemotherapy on Malignant Pleural Effusions

Objective To summarize the effect and superiority of intrapleural circular hyperthermic perfusion chemotherapy (ICHPC) on malignant pleural effusions.Methods Forty patients with malignant pleural effusions (MPEs) underwent pleural biopsy under general anesthesia with unilateral ventilation.After breaking up the pleural adhesions,the stable temperature 43℃ liquid containing saline solution 3000 mL and DDP 300 mg was circularly perfused into the pleural cavity for one hour through by-pass machine.Results Symptoms such as dyspnea,shortness of breath and chest discomfort disappeared,and MPEs were effectively controlled.In all patients,the KPS score was over seventy.Moreover,the concentration of CEA,CYFRA21-1,and NSE dramatically descended.Mass necroses with pleural carcinomatoid were observed in post-treatment microscopy.And chromatin condensation,apoptotic body occurrence and nuclear fragmentation in tumor cells were found in post-treatment electron microscopy.Eventually,tumor cells died.Conclusions ICHPC shows satisfactory therapeutic effect on MPEs with less adverse reactions and invasiveness.It is also suitable for elderly and rigid patients with MPEs.