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 …     

心包内置管治疗恶性心包积液17例

目的 研究心包内置管引流并注入化疗药物,白介素Ⅱ治疗恶性心包积液的疗效。方法 17例,经皮穿刺将中心静脉导管置入心包腔,基本排尽积液后注入化疗药物及白介素Ⅱ。结果 17例中6例完全缓解,10例部分缓解。结论 此方法治疗恶性心包积液安全有效。     

心包内置管治疗恶性心包积液17例

目的 研究心包内置管引流并注入化疗药物，白介素Ⅱ治疗恶性心包积液的疗效。方法 17例，经皮穿刺将中心静脉导管置入心包腔，基本排尽积液后注入化疗药物及白介素Ⅱ。结果 17例中6例完全缓解，10例部分缓解。结论 此方法治疗恶性心包积液安全有效。     

心包腔内置入中心静脉导管治疗恶性心包积液 51 例临床观察

目的：探讨心包腔内置人中心静脉导管治疗恶性心包积液的安全性。方法：经细胞学确诊的51例恶性心包积液患者，随机分为治疗组（26例）和对照组（25例）。常规心包腔穿刺，置人中心静脉导管引流心包积液。治疗组置管引流联合腔内注射CBP300mg＋干扰素（IFNa-2b）600万u＋PYM16mg，每周2次，共4—6次；对照组单纯置管引流。结果：可评价疗效病例49例，近期有效率治疗组（25例）心包积液量减少的CR、PR、PD分别是44．0％、32．0％、24．0％，对照组（24例）分别是1％、16．7％、79．2％，两组比较有统计学意义（P〈0．005）。治疗组3个月、6个月、12个月生存率分别为87．50％、58．08％、29．17％，中位生存时间为8个月。对照组分别为58．33％、33．33％、0，中位生存时间为5．3个月。两组差异有显著意义（P〈0．01）。结论：心包腔内置入中心静脉导管引流联合细胞毒药物和IFNa-2b腔内治疗恶性心包积液有效、方便、安全。     

心包腔内置入中心静脉导管治疗恶性心包积液51例临床观察

目的：探讨心包腔内置人中心静脉导管治疗恶性心包积液的安全性。方法：经细胞学确诊的51例恶性心包积液患者，随机分为治疗组（26例）和对照组（25例）。常规心包腔穿刺，置人中心静脉导管引流心包积液。治疗组置管引流联合腔内注射CBP300mg＋干扰素（IFNa-2b）600万u＋PYM16mg，每周2次，共4—6次；对照组单纯置管引流。结果：可评价疗效病例49例，近期有效率治疗组（25例）心包积液量减少的CR、PR、PD分别是44．0％、32．0％、24．0％，对照组（24例）分别是1％、16．7％、79．2％，两组比较有统计学意义（P〈0．005）。治疗组3个月、6个月、12个月生存率分别为87．50％、58．08％、29．17％，中位生存时间为8个月。对照组分别为58．33％、33．33％、0，中位生存时间为5．3个月。两组差异有显著意义（P〈0．01）。结论：心包腔内置入中心静脉导管引流联合细胞毒药物和IFNa-2b腔内治疗恶性心包积液有效、方便、安全。     

经皮置管引流加腔内化疗治疗恶性心包积液26例分析

目的 探讨心包内置管引流并注入化疗药物DDP或ADM治疗恶性心包积液的疗效。方法 对26例恶性心包积液患者经皮穿刺将中心静脉导管置入心包腔，尽可能排尽积液后注入化疗药物。结果 26例中12例完全缓解，9例部分缓解。结论 经皮置管引流加腔内化疗不失为一种治疗恶性心包积液的好方法。     

经皮心包腔内置管化疗治疗恶性心包积液

近年来,恶性肿瘤的发病率在不断增加,恶性心包积液患也有增多趋势,易造成急、慢性心包填塞,如不及时治疗会造成死亡。以往对恶性心包积液行单纯心包穿刺抽液治疗,由于抽液不彻底,引流不尽,即使腔内注射化疗药物,效果也较差,且反复穿刺容易引起心脏损伤等并发症。我院2000年1月至2003年1月开展心包腔内置管化疗取得了满意的疗效,现报告如下：     

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。     

微管引流灌注顺铂治疗中等或大量恶性心包积液80例临床观察

目的评价微管心包腔闭式引流灌注顺铂治疗中等或大量恶性心包积液的疗效。方法将80例中等量或大量恶性心包积液行微管心包腔闭式引流术；心包积液引净后注入顺铂（DDP）80mg。结果CR30例（37．5％），PR40例（50．0％），有效率87．5％（70／80），中位生存期205d；引流量（500～2800mL）明显多于既往常规心包穿刺抽液（100～500mL）。结论微管引流灌注顺铂治疗中大量恶性心包积液疗效佳，且安全、方便、易行，可作为治疗中大量恶性心包积液的首选方法。     

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。     

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。     

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。     

A case of recurrent breast cancer complicated with pericardial effusions and cardiac tamponade

A 56-year-old female with breast cancer after left partial mastectomy and subaxillary lymph node dissection was treated with adjuvant chemoradiotherapy. After one year left lung metastasis and malignant pleural effusion had resisted and progressed against several types of chemotherapy. Although combination chemotherapy of trastuzumab and vinorelbine was started, pericardial effusions progressed. Emergent pericardiocentesis was performed, and the catheter was left in the pericardial space. The adenocarcinoma was detected from effusion. On days 3, 5 and 7, after further pericardial drainage, the intracavitary treatment with a 15 mg bolus of thiotepa and 30 mg hydrocortisone was administered, and the catheter was removed the following day. The recurrence of pericardial effusions was not seen in four months until death. Pericardiocentesis and intrapericardial instillation of thiotepa were effective in our case with pericardial effusions.     

热疗联合胸腔置管化疗治疗恶性胸腔积液临床研究

目的观察热疗联合胸腔置管化疗治疗恶性胸腔积液的临床疗效及其毒副反应。方法62例恶性胸腔积液患者随机分为射频热疗联合胸腔置管化疗组(治疗组)和单纯胸腔置管化疗组(对照组)各31例。对照组先行胸腔闭式引流后,将顺铂60 mg、氟尿嘧啶1.0 g、吡喃阿霉素40 mg各加生理盐水50 ml胸腔内注射,再将地塞米松20 mg胸腔内注射后夹管,每周1次,灌注2次后拔管观察,治疗组于胸腔注射药物后行热疗,当周再行1次单纯热疗,一疗程4次。结果对照组胸腔积液控制有效率为54.8%,治疗组为83.9%,两组差异有显著性(P<0.05)。对照组生活质量改善率为48.4%,治疗组为77.4%,两组差异有显著性(P<0.05)。两组化疗毒副反应发生率差异无显著性。与热疗相关的毒副反应为局部皮肤疼痛4例(13.0%),皮下脂肪硬结3例(9.7%)。结论热疗联合胸腔置管化疗治疗恶性胸腔积液是一种安全可靠、高效低毒的治疗方法,值得临床推广使用。     

A case of malignant pericardial effusion due to breast cancer successfully controlled by intrapericardial chemotherapy using pirarubicin]

We report a case of malignant pericardial effusion due to breast cancer that was successfully controlled by intrapericardial chemotherapy using pirarubicin. A 53-year-old woman underwent breast conserving therapy for left breast cancer in 1996. She was given CAF therapy and UFT as adjuvant therapy. Three years and 10 months after operation, she had malignant pericardial and pleural effusion. Pericardiocentesis and pleurocentesis were performed immediately. Pericardial effusion relapsed after some time and she was treated with intrapericardial chemotherapy using pirarubicin. After this treatment she has not suffered from pericardial effusion for 1 year and 4 months to date. This case suggests that intrapericardial chemotherapy is effective for malignant pericardial effusion.     

Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study

Background

Local (intrapericardial) chemotherapy has been reported to be useful for the treatment of neoplastic pericardial disease, but it has never been compared to systemic chemotherapy, a combination of the two and simple pericardial drainage or sclerosis.

Methods

We analyzed the clinical and echocardiographic data of 119 patients, suffering of neoplastic pericarditis due to lung cancer (97 with non-small-cell), comparing the outcomes of four different treatment strategies (extended catheter drainage/sclerosis, systemic chemotherapy, local chemotherapy, and combined - local plus systemic - chemotherapy) at the last available follow-up or at the change of therapy after a treatment failure. The outcomes (based on semiquantitative evaluation of pericardial disease) were classified as complete, partial, no response and progressing disease.

Results

A complete response was achieved in 37/53 of patients with combined, in 12/22 with local, in 5/27 with systemic chemotherapy, respectively, and in 4/17 after drainage/sclerosis (p < 0.001). Overall response was achieved in 51/53 with combined, 18/22 and 16/27 with local or systemic chemotherapy, respectively, and in 5/17 with drainage/sclerosis only (p < 0.001). Survival was significantly better after combined chemotherapy (p < 0.001) and 12/53 patients (23%) in this subgroup survived more than 1 year. The overall response rate was higher with intrapericardial cisplatinum than with other agents (98% vs 80%, χ² = 7.69, p < 0.01).

Conclusions

Local chemotherapy, alone or with systemic chemotherapy, is effective in treating pericardial metastases from lung carcinoma, leading to a good control of pericardial effusion in 92% of cases, and to complete disappearance of effusion and masses in 65%. Combined therapy is significantly better than any other treatment. Pericardiocentesis and intrapericardial chemotherapy should be used whenever possible in lung cancer neoplastic pericardial disease, not only in case of tamponade.     

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.     

The Incidence of Cardiac Metastasis in Primary Lung Cancer and the Management of Malignant Pericardial Effusion

The incidence of metastasis to the heart and pericardium was35% in post-mortem studies of 150 cases of carcinoma of thebronchus. Twenty-one patients with malignant pericardial effusion fromcarcinoma of the bronchus were treated at the National CancerCenter Hospital during the last three years. Fifteen patientswere treated by creating a pericardial window through a subxiphoidapproach without complications or mortality, in these 15 patientscardiac compression caused by pericardial effusion was promptlyrelieved by the creation of the pericardial window. There wasno reaccumula tion of the effusion in five of six patients treatedby the pericardial window procedure with intrapericardial instillationof chemotherapeutic agents and eight of nine patients treatedby creating the window without local chemotherapy. On the otherhand cardiac tamponade was controlled in one of three patientsby repeated pericardiocenteses. The median survival periodsfrom the initiation of treatment for the effusion up to deathwere 4 mo in six patients treated by the pericardial windowprocedure with intrapericardial instillation of chemotherapeuticagents, 2 mo in nine patients treated by the window techniquewithout local chemotherapy and 0.8 mo in six patients in whoma pericardial window was not created. The median survival of15 patients treated by the pericardial window procedure (2 nio)was not significantly longer than that of six patients not sotreated. We have come to the conclusion that the creation of a subxiphoidpericardial window is a safe, effective and reliable treatmentprocedure for the manage ment of malignant pericardial effusion,but the prognosis for survival in patients with malignant pericardialeffusion may depend principally on the extent of the primarytumor and the performance status of patients at the initiationof treatment for the effusion.     

铜绿假单胞菌注射液治疗恶性胸腔积液和心包积液的临床分析

目的观察铜绿假单胞菌注射液治疗恶性胸腔积液和心包积液的疗效。方法共治疗恶性胸腔积液、心包积液26例。所有患者先行中心静脉导管置管进行积液引流,引流后注入铜绿假单胞菌注射液2～5ml和地塞米松5mg,2%利多卡因10ml,夹闭引流管48h,再开放引流管,根据引流情况连续注药2～3次。结果治疗恶性胸腔积液20例,有效18例（90.0%）;恶性心包积液10例均有效,不良反应为胸痛、气短、发热。结论铜绿假单胞菌注射液应用于恶性胸腔积液、心包积液的治疗,疗效较满意。