42例恶性心包积液的临床处理

目的观察恶性心包积液心包穿刺置管引流及实施腔内化疗的疗效及安全性。方法42例有症状的恶性心包积液患者行心包穿刺置管术,术后以生理盐水30mL稀释40～60mg顺铂行腔内化疗,观察疗效及毒副反应。结果42例患者中腔内化疗完全缓解20例,部分缓解20例,无效2例,有效率95.2%,不良反应轻微。结论对有症状的恶性心包积液行心包穿刺置管引流及腔内化疗,效果显著,安全性高,应首选采用。     

经皮心包腔置管治疗恶性心包积液

恶性心包积液经皮心包腔置管，缓慢放出积液后注射康莱特 胞必佳，3例患者2周心包腔内注射药物3次，2例注射2次，心包积液完全控制，未出现心包腔内感染。     

心包置管持续引流并干扰素腔内给药治疗恶性心包积液

目的：探讨经皮心包置管持续引流并干扰素腔内给药治疗恶性心包积液的疗效。方法：33例恶性心包积液患者，以美国产ARROW牌产品，穿刺成功后，心包腔留置静脉导管，持续引流，并以干扰素针1500万u腔内注入，2－3天后重复引流并再给药1次。结果：33例中完全缓解20例，好转10例，有效率90．9％（30／33），结论：此法是一种集救、诊断、病因治疗为一体的心包置管引流方法，安全可靠，效果较好。     

心包置管持续引流并干扰素腔内给药治疗恶性心包积液

目的　探讨经皮心包置管持续引流并干扰素腔内给药治疗恶性心包积液的疗效。方法　 33例恶性心包积液患者 ,以美国产ARROW牌产品 ,穿刺成功后 ,心包腔留置静脉导管 ,持续引流 ,并以干扰素针 15 0 0万u腔内注入 ,2～ 3天后重复引流并再给药 1次。结果　 33例中完全缓解 2 0例 ,好转 10例 ,有效率 90 9% ( 30 /33)。结论　此法是一种集急救、诊断、病因治疗为一体的心包置管引流方法 ,安全可靠 ,效果较好。     

经皮置管心包腔内灌注博来霉素治疗肺癌心包积液

肺癌转移或直接侵犯心包引起恶性心包积液 ,恶性心包积液的特点是生长快 ,积液量大 ,易造成急、慢性心包填塞[1] ,心包填塞通常采用心包穿刺抽液 ,心包穿刺抽液不能控制复发。 1996年 1月以来我们采用经皮心包腔内留置中心静脉导管灌注日本生产的博来霉素 (bleomycin ,BLM)联合全身化疗、病灶局部放疗 ,治疗 12例晚期肺癌并发恶性心包积液患者 ,疗效满意。材料和方法一　研究对象　 1996年 1月～ 2 0 0 1年 12月我院收治经细胞学或组织学证实的非小细胞肺癌并发恶性心包积液患者共 12例 ,男 7例 ,女 5例 ,年龄 19～ 70岁 ,中位年龄 4 3岁…     

心包腔内置管化疗治疗恶性心包积液

肿瘤急症之一的恶性心包积液 ,如不及时治疗 ,患者会因心包填塞而死亡。我院 1 993年 1月～ 2 0 0 0年 1月共收治恶性心包积液患者 42例 ,其中 2 0例行单纯心包抽液治疗 ,2 2例行心包腔内置管化疗 ,现将结果报告如下。1　材料和方法1 .1　临床资料　本组 42例患者随机分为两组 ,2 0例单纯心包穿刺抽液组男性 1 4例 ,女性 6例 ,年龄42～ 63岁 ,中位年龄 5 2 .2岁。其中少量积液 ( <2 0 0ml) 1例 ,中等量积液 ( 2 0 0～ 5 0 0 ml) 1 3例 ,大量积液( >5 0 0 ml) 6例。 2 2例心包腔置管化疗组男性 1 4例 ,女性 8例 ,年龄 43～ 62岁 ,中位年龄 5 …     

经皮心包腔置管治疗恶性心包积液

恶性心包积液经皮心包腔置管 ,缓慢放出积液后注射康莱特 胞必佳。 3例患者 2周心包腔内注射药物 3次 ,2例注射 2次 ,心包积液完全控制 ,未出现心包腔内感染     

沙培林与顺铂治疗恶性心包积液的近期疗效

［目的］观察沙培林(OK-４３２)及顺铂治疗恶性心包积液的近期疗效和耐受性。［方法］５６例中等及大量恶性心包积液患者心包穿刺置管引流后腔内随机分组注射，沙培林组(生理盐水２０ml＋OK-４３２２KE＋地塞米松１０mg／次)３０例，顺铂组(生理盐水４０ml＋顺铂５０mg～６０mg／次)２６例，腔内用药最多重复３次。［结果］沙培林组有效率为９３．３％。主要不良反应为发热；顺铂组有效率为６５．４％，主要不良反应为骨髓抑制及胃肠道反应，两组有效率及不良反应均有显著差异(P＜０．０５)。［结论］沙培林治疗恶性心包积液沙培林有效率高，不良反应小，患者耐受性好，值得临床推广应用。     

恶性心包积液的临床处理(附48例分析)

目的：观察恶性心包积液心包穿刺置管引流并实施腔内化疗的疗效及安全性。方法：在48例恶性心包积液中，19例有心包填塞症状者行心包穿刺置管并腔内化疗。29例无心包填塞症状未行腔内治疗的恶性心包积液患者均接受了全身化疗。结果：腔内化疗完全缓解9例，好转8例，无效1例，有效率89．5％，未行腔内化疗的恶性心包积液患者接受了全身化疗，有效率34．5％，结论：在心包积液量较大时，应首选腔内注药后治疗，安全有效，不良反应小。     

恶性心包积液置管引流并腔内化疗的疗效观察

为探讨B超引导下心包内穿刺并置管引流加腔内化学药物注入治疗恶性心包积液的疗效。对58例恶性心包积液患者在B超引导下经皮穿刺进入心包腔后置入导丝，沿导丝将中心静脉导管置入心包腔，彻底引流后每周给予化学药物治疗。经治疗后17例完全缓解，21例部分缓解，有效率为65．5％。无心包缩窄及窦道形成。初步研究结果提示，心包内穿刺置管引流加腔内化疗治疗恶性心包积液，具有方便、有效、安全等特点，有助于延长晚期肿瘤患者的生存期和提高其生活质量。     

Local application of anti-cancer drugs for the treatment of malignant pleural and pericardial effusion

Pleural effusion is a common complication in patients with malignant neoplasm. A randomized controlled study of intrapleural instillation of Adriamycin (control group, 30 patients) and Adriamycin Nocardia rubra cell wall skeleton (N-CWS group, 26 patients) with tube thoracostomy was performed in 55 patients with malignant pleural effusion due to primary lung cancer. The response rates for control of pleural effusion were 73.4% in the N-CWS group and 46.1% in the N-CWS group. These results suggest that intrapleural instillation using a combination of anti-cancer agent and immunopotentiator is an effective treatment for malignant pleurisy. Cardiac tamponade secondary to cancer is a life-threatening complication requiring immediate treatment. Twenty-four patients with malignant pericardial effusion were treated by intrapericardial instillation of anti-cancer drugs, such as Carbazilquinone, Mitomycin-C or ACNU, with pericardial drainage. The range of survival time from the instillation of anti-cancer drug was 3-365 days (average days). In only 4 patients, reaccumulation of pericardial effusion was recognized. There were no serious complications with this procedure. It was considered that local instillation of anti-cancer agents with pericardial drainage was a useful therapeutic modality for malignant pericarditis.     

VP-16联合DDP心包腔内注射治疗非小细胞肺癌恶性心包积液

背景与目的:心包穿刺抽液后心包腔内药物治疗是治疗恶性心包积液的主要手段。本研究观察足叶乙甙(VP-16)联合顺铂(DDP)心包腔内注射治疗非小细胞肺癌恶性心包积液的疗效及不良反应。方法:对28例非小细胞肺癌恶性心包积液的患者行心包穿刺术,尽可能抽尽液体后心包腔内注入VP-16200～300mg和DDP80～100mg,局部治疗后2周行全身化疗。结果:28例患者首次治疗有效率85.7%,完全缓解率71.4%,2次治疗总有效率100%。仅4例患者需行二次穿刺治疗。治疗后胃肠道反应16例,主要为Ⅰ～Ⅱ度;骨髓抑制12例,主要为Ⅰ度;转氨酶轻度升高1例。24例初治患者中,ⅢB期患者中位生存期14个月,Ⅳ期患者中位生存期10.9个月;复发的4例患者中位生存期6个月(从复发日起计算)。结论:心包穿刺抽液加心包腔内注入VP-16联合DDP是恶性心包积液有效的治疗方法。     

Treatment of malignant pericardial effusion with 32P-colloid.

Malignant pericardial effusion is usually treated only when signs of cardiac tamponade develop. Several methods of treatment have been reported with an overall response rate of approximately 75%. Since our initial study using intrapericardial 32P-colloid instillation as a treatment modality for pericardial effusion demonstrated a significant higher response rate, this study was conducted to further evaluate the efficacy of intrapericardial 32P-colloid in terms of response rates and duration of remissions. Intrapericardial instillation of 185-370 MBq (5-10 mCi) 32P-colloid in 36 patients with malignant pericardial effusion resulted in a complete remission rate of 94.5% (34 patients) whereas two patients did not respond to treatment due to a foudroyant formation of pericardial fluid. The median duration time was 8 months. No side-effects were observed. These results suggest that intrapericardial instillation of 32P-colloid is a simple, reliable and safe treatment strategy for patients with malignant pericardial effusions. Therefore, since further evidence is provided that 32P-colloid is significantly more effective than external radiation or non-radioactive sclerosing agents, this treatment modality should be considered for the management of malignant pericardial effusion.     

心包腔内注入重组改构人肿瘤坏死因子治疗恶性心包积液的疗效分析

Objective: To evaluate the therapeutic efficacy of injecting recombinant mutant human tumor necrosis factor (rmhTNF) into pericardial cavity of carcinoma patients with malignant pericardial effusion. Methods: In 20 cases of malignant pericardial effusion, the intrapericardial catheter was inserted into pericardial cavity, and then rmhTNF of 1.5 × 107 U was infused. The infusion was repeated every 5-7 days with the total 4-6 times. If the effusion disappeared, rmhTNF was then used 2 more times and then the intrapericardial catheter was pulled out. Results: Of 20 patients, 14 were complete response (CR), 4 were partial response (PR) and 2 no change (NC). The disappearance of effusion in 6 cases lasted for more than 6 months. Conclusion: Injecting rmhTNF into pericardial cavity may be a better way to control malignant pericardial effusion and has mild side effects.     

微管心包腔闭式引流术治疗恶性心包积液的临床观察

目的评价微管心包腔闭式引流治疗恶性心包积液的疗效。方法将42例恶性心包积液患者随机分为微管心包腔闭式引流术引净后注入顺铂(DDP)的治疗组21例,常规心包穿刺抽液后注入DDP的对照组21例。结果治疗组有效率(CR+PR)为90·4%(19/21),中位生存期为199d;对照组有效率(CR+PR)为47·6%(10/21),中位生存期为106d。结论微管心包腔闭式引流术治疗恶性心包积液的疗效佳,且安全、方便、易行,可作为治疗恶性心包积液的首选方法。     

经皮置管对恶性心包积液的诊断和治疗(附34例报告)

目的　对于恶性心包积液者 ,经皮一次心包穿刺置管达到急救、诊断和对因治疗。方法34例拟诊为恶性心包积液者 ,穿刺心包成功后 ,经针尾部置入外径 1.8mm引流管 ,以医用三通将引流管与引流袋连通。收集引流袋内积液中类似组织状的凝集块 ,按组织活检标本处理后光镜检查 ;同时送检积液细胞学。病因明确者 ,心包内注入抗癌药 4h后再开放引流 ,引流量连续 2天≤ 30ml/ 2 4h时拔管。结果　 34例均一次置管成功 ,心包填塞症状于 15～ 6 0min解除。凝集块阳性率 91.2 % ,细胞病理分型确定率 10 0 % ;细胞学阳性率 6 1.8% ,细胞病理分型确定率 81.0 %。两种方法比较 ,差异均有显著性 (P <0 .0 0 5 ,P <0 .0 2 5 )。凝集块和细胞学两种方法相加阳性率 94.1%。 2 9例心包内注入抗癌药行局部化疗。 33例置管引流时间平均 6d。结论　此法是一种集急救、诊断、对因治疗为一体的心包置管引流方法 ;以积液凝集块细胞病理学作为病因诊断的手段 ,是一种无创、阳性检出率高的病理标本获取和检查方法。     

恶性心包积液置管引流并腔内化疗的疗效观察

为探讨B超引导下心包内穿刺并置管引流加腔内化学药物注入治疗恶性心包积液的疗效。对58例恶性心包积液患者在B超引导下经皮穿刺进入心包腔后置入导丝,沿导丝将中心静脉导管置入心包腔,彻底引流后每周给予化学药物治疗。经治疗后17例完全缓解,21例部分缓解,有效率为65.5%。无心包缩窄及窦道形成。初步研究结果提示,心包内穿刺置管引流加腔内化疗治疗恶性心包积液,具有方便、有效、安全等特点,有助于延长晚期肿瘤患者的生存期和提高其生活质量。     

Management of malignant pericardial effusion resulting from recurrent cancer with local instillation of aclarubicin hydrochloride.

To determine the efficacy of aclarubicin hydrochloride in local control of malignant pericardial effusion, the authors carried out a trial of pericardial drainage with local administration of this agent in five patients, whose effusions had produced cardiac tamponade. All patients were women, and their primary cancers, all initially treated surgically, had arisen in the breast (two patients), or lung (three patients). Mean patient age was 54.2 years (range, 43-62). In four patients, improvement permitted removal of the drainage catheter. Two patients (40%) had a complete remission of the malignant pericardial effusion. The other three patients were difficult to evaluate because nonpericardial metastases limited their survival. All patients, however, showed disappearance of malignant cells from the pericardial sac with no cytopathologically demonstrable recurrence. In our few patients, intrapericardial aclarubicin appeared to be highly effective against malignant pericardial effusion.     

Ultrasound-guided small-bore Elecath tube insertion for the rapid sclerotherapy of malignant pleural effusion

BACKGROUND: Traditional pleurodesis for malignant pleural effusion is performed by large-bore chest tube insertion with the instillation of sclerosing agents after the compressed lung re-expansion and pleural fluid drainage of 100-150 ml/day. This study was carried out to evaluate the possibility of rapid sclerotherapy for malignant pleural effusions by insertion of a small-bore Elecath tube (12-French) under ultrasound guidance and intrapleural injection of bleomycin 60 IU. METHODS: Twenty-six patients, with 28 cytopathologically proven malignant pleural effusions (two patients had bilateral pleural effusions) and receiving the insertion of the Elecath tube for drainage, were included in our series. This rapid and short-term sclerosing method was performed and completed by intrapleural injection of bleomycin when the pleural effusion had been clearly drained by the small-bore Elecath tube and the compressed lung had fully re-expanded on follow-up chest radiographs. RESULTS: Twenty patients with 22 pleural effusions underwent the intrapleural injection of bleomycin, with the results of pleurodesis being complete response 41% (9/22), partial response 36% (8/22) and failure 23% (5/22). Interestingly, among the 17 successful procedures of pleurodesis (complete response and partial response), 71% (12) procedures could be completed within 2 days (seven within one day and five within 2 days). The remaining unsuccessful procedures carried out on six patients without the injection of bleomycin were due to a non-re-expanded lung (n = 3) and inadequate drainage (n = 3); of these, four patients also received the large-bore chest tube insertion after the removal of the Elecath tube, but the compressed lung still could not re-expand. The complications of the bleomycin injection were fever [77% (17/22)], vomiting [14% (3/22)] and hiccup [5% (1/22)]. CONCLUSION: The method of rapid sclerotherapy for malignant pleural effusions by small-bore Elecath tube is promising, with a success rate achieving 77%, usually within 2 days.      

Intrapericardial OK-432 instillation for the management of malignant pericardial effusion

Ten patients with malignant pericardial effusion were treated with intrapericardial injection of OK-432 (penicillin-treated and heat-treated lyophilized powder of the substrain of Streptococcus pyogenes A3). After intrapericardial insertion of a catheter, a maximal volume of pericardial fluid was withdrawn with cytologic confirmation of malignancy. Five or 10 Klinische Einheit (KE) (KE is a unit used to express the strength of a preparation) of OK-432 diluted in 20 ml of saline was injected into the pericardial space in seven and three patients, respectively. It was repeated in case of reaccumulation. Seven patients were treated only once and the remaining three required a second treatment. Complete control of pericardial effusion was achieved in all patients for an average of 329 days (range, 54 to 790 days). Fever and chest pain were experienced in six and five patients, respectively, but were controlled with antipyretics. Two of three patients who received 10 KE of OK-432 experienced hypotension that was successfully controlled with vasopressor drugs with or without reaspiration of pericardial fluid. Rapid reactive reaccumulation of the pericardial fluid was thought to be a cause of hypotension. A follow-up computed tomography (CT) scan was performed in seven patients and a thickened pericardium was noticed in five; no patients had constrictive pericarditis. These results suggest that intrapericardial administration of 5 KE of OK-432 is an effective and safe treatment for malignant pericardial effusion.