B超引导下持续循环胸腔热灌注治疗恶性胸腔积液的可行性及临床疗效初探

目的评价B超引导下持续循环胸腔热灌注（continuous circularory intrapleural perfusion hyperthermia，CCIPH）治疗各种恶性肿瘤引起的恶性胸腔积液的可行性、临床疗效及毒副反应。方法选取13例恶性肿瘤合并胸膜转移、胸腔积液患者，经胸片或胸部CT明确存在中一大量胸腔积液，且胸腔积液经细胞学检查明确可查见癌细胞。本组13例患者均在B超引导定位下行胸腔穿刺置管术，分别留置灌注管和排液管，所有操作均在局麻下进行。灌注液为蒸馏水，总量约2500～3500ml，灌注速度300～400ml／min，灌注时间60min，治疗温度（48±0．2）℃，每例灌注2～3次，两次治疗之间时间间隔为48h。结果所有13例患者均顺利进行B超引导下CCIPH，人体温度为（48．00±0．20）℃，出体温度为（44．98±0．22）℃。患者均耐受良好。9例患者胸腔积液完全缓解，4例部分缓解。CCIPH后1个月左右复查胸部CT，发现肺部原发灶缩小者6例，基本不变者7例。患者KPS评分上升均在10分以上，肿瘤标志物不同程度下降，无严重副作用。结论B超引导下CCIPH治疗恶性胸腔积液安全性高，患者耐受良好，方法简便易行，近期疗效满意。

Continuous circulatory intrapleural perfusion hyperthermia under B ultrasound guidance for malignant pleural effusion

Objective To assess the feasibility, clinical efficacy and toxicities of continuous circulatory intrapleural perfusion hyperthermia（CCIPH ） under B ultrasound guidance in the treatment of malignant pleural effusion（MPE） caused by various kinds of carcinoma. Methods CCIPH B ultrasound guidance was carried out in 13 patients with carcinoma complicated by malignant pleural effusion. Pleural effusion was proved by chest roentgenogram studies or computed tomography in all patients. Pleurocentesis was performed before CCIPH. Malignant cell was found in the pleural effusion of all the patients. Tow tubes for irrigation inlet and outlet, which were inserted into the pleural cavity under the positioning of B ultrasound, were connected to BR-TRG-I-type hyperthermic perfusion intraperitonela treatment system （Guangzhou, China）. All operations were performed under local anesthesia. The thoracic cavity was irrigated for 60 min with （ 48.00 ±0.20 ） ℃ distilled water （about2, 500-3, 500 ml） 300- 400 ml/min. CCIPH was carried out for 2 or 3 times, with a 48 h interval. Results All patients successfully completed this treatment with acceptable toxicities and stable inlet temperature of （ 45.00 ± 0.20 ） ℃ and outlet temperature of （ 44.98 ± 0.22 ） ℃ and without serious side effects. The control rate of pleural effusion was 100%. CT performed in 6 cases about t month after CCIPH showed that the primary focus in lung dwindled, and remained unchanged in 7 cases. The KPS was improved in all the cases. Tumor markers were decreased. Conclusion This less invasive modality seems to offer a safe, feasible and excellent local control for MPE.