重组腺病毒p53治疗老年恶性胸腔积液的临床研究

目的 观察胸腔内注入重组人p53腺病毒治疗老年恶性胸腔积液的近期疗效和毒副反应.方法 恶性胸腔积液患者39例,常规胸腔穿刺,尽量抽净胸腔积液,观察组20例,胸腔内注入重组人p53腺病毒(今又生,深圳市赛百诺基因技术有限公司生产)1×1012VP;对照组19例,胸腔内注入重组人白细胞介素2(泉奇,IL-2)200万国际单位,均为每周1次,连用4 w;观察近期疗效及毒副反应.结果 治疗后4 w观察组总有效率(CR+PR)为80%,对照组总有效率(CR+PR)为40.53%,两组比较具有显着性差异(P＜0.05);生活质量方面,两组均有改善,而观察组要明显优于对照组;副作用方面,发热、骨髓抑制、消化道症状观察组与对照组比较无显着性差异.结论 重组人p53腺病毒胸腔内注入治疗老年恶性胸腔积液临床应用安全有效,短期内应用可有效控制胸腔积液,改善生活质量.     

重组人p53腺病毒治疗肺腺癌恶性胸腔积液的临床疗效

目的观察短期内胸腔内注射重组人p53腺病毒缓解肺腺癌所致恶性胸腔积液的效果和毒副作用。方法纳入肺腺癌所致恶性胸腔积液的患者226例,随机分成Ⅰ组、Ⅱ组和Ⅲ组,均给予胸腔置管,反复引流并尽可能排净胸腔积液。Ⅰ组76例,胸腔内注入重组人p53腺病毒注射液1×1012VP;Ⅱ组82例,胸腔内注入顺铂30 mg/m2;Ⅲ组68例,注入重组人p53腺病毒注射液1×1012VP 72 h后注入顺铂30 mg/m2,1次/w,共注射4 w。结果Ⅰ组有效率(CR+PR)84.2%,Ⅱ组46.3%,Ⅲ组85.3%,Ⅰ组、Ⅱ组,Ⅲ组和Ⅱ组比较具有显著差异(P0.05),Ⅰ组和Ⅲ组间无明显差异(P0.05);3组生活质量均有提高,而Ⅰ组和Ⅲ组提高幅度明显优于Ⅱ组(P0.05),Ⅰ组和Ⅲ组比较差异无统计学意义(P0.05);副作用方面,除发热外,食欲下降、白细胞下降Ⅰ组明显少于Ⅱ组和Ⅲ组(P0.05)。结论重组人p53腺病毒注射液短期内注射入胸腔对于缓解肺腺癌所致恶性胸腔积液有效,毒副作用较少,可提高生活质量,是一种治疗肺腺癌恶性胸腔积液的新方法。     

重组人p53腺病毒联合顺铂治疗NSCLC合并胸腔积液临床研究

目的本研究评价重组人p53腺病毒注射液（rAd-p53）联合顺铂治疗肺癌所致胸腔积液的临床疗效和毒副反应。方法将38例非小细胞肺癌（NSCLC）合并胸腔积液患者随机分为治疗组和对照组两组。所有患者均在第1、8 d应用吉西他滨1.0 g/m2静脉点滴,每3周重复1次。在上述治疗基础上,治疗组胸腔内注入rAd-p53 1×10^12 VP和顺铂30 mg/m2每次;对照组仅胸腔内注入顺铂30 mg/m2每次,两组均每周重复1次,连用4次后观察疗效。结果治疗组和对照组的有效率分别为80.95%和47.06%（P〈0.05）;治疗组和对照组的一般状况改善率分别为66.67%和29.41%（P〈0.05）;两组患者主要不良反应均为发热、胸痛、消化道反应及白细胞减少,治疗组发热的发生率高于对照组（P〈0.05）,主要为自限性,36 h后一般都能自行恢复。结论重组人p53腺病毒注射液联合顺铂治疗肺癌所致胸腔积液疗效确切,安全,值得临床推广使用。     

重组改构人肿瘤坏死因子胸腔灌注治疗恶性胸腔积液临床观察

目的 观察胸腔灌注重组改构人肿瘤坏死因子治疗恶性胸腔积液的疗效。方法 对32例恶性胸腔积液患者经胸腔引流管将重组改构人肿瘤坏死因子注入胸腔内治疗。结果 CR5例，PR21例，NC6例。有效率81．2％。结论 该方法操作简单，副作用少，能有效控制恶性胸腔积液。     

肺癌引起的恶性胸腔积液的研究和治疗进展

肺癌引起的恶性胸腔积液(malignant pleural effusion,MPE)发病率高且临床治疗效果不佳.出现MPE的肺癌患者生活质量明显下降,病死率明显增高.近期科学研究对MPE的病理生理过程进行了更多的阐述——宿主胸膜受肿瘤侵犯后分泌大量血管活性物质,促成了适合肿瘤生长的微环境和MPE的形成,同时肿瘤细胞通过激活某些信号通路、分泌重要的炎症介质来募集宿主细胞.同样地,宿主细胞也可激活细胞内信号通路、分泌炎症介质影响肿瘤细胞的功能.两者共同影响肿瘤的生长和MPE的产生.一些生物实验为MPE的形成提供了新的靶向治疗的方法,并且其得到的阳性结果为后续MPE的治疗提供了新的思路.     

重组人血管内皮抑素对恶性胸腔积液的治疗效果

目的 比较胸腔注入不同剂量重组人血管内皮抑素对Ⅳ期肺腺癌伴胸腔积液的临床效果。方法 回顾性分析2019年1月-2021年5月于我院就诊的Ⅳ期肺腺癌伴恶性胸腔积液患者140例,其中对照组、观察组分别70例,对照组：胸腔注入重组人血管内皮抑素45mg d1,d4,d7,4周一次;观察组：胸腔注入重组人血管内皮抑素90mg d1,d7,4周一次,连续3次为一疗程,最多2疗程。观察两组治疗患者临床症状缓解、生活质量及不良反应情况。结果 观察组临床症状缓解率(51.43%)高于对照组(34.29%,P<0.05)。观察组日常生活改善能力(84.29%)高于对照组(74.29%,P<0.05)。两组不良反应轻微,为0～I级,毒副作用小。结论 重组人血管内皮抑素90mg d1,7/4周胸腔注入可有效减少恶性胸腔积液生成、改善患者生活质量、提升临床疗效,且不良反应小,值得推广。     

分子靶向药物治疗非小细胞肺癌相关恶性胸腔积液和恶性心包积液

<正>肺癌大多数起源于支气管黏膜上皮,其发病率和死亡率较高〔1〕。在肺癌的发展过程中,部分患者伴有并发的恶性胸腔及心包积液。其中老年患者又是一个特殊群体,年龄大、体质相对较差,基础病较多,器官功能储备差。因此对于老年患者的恶性胸腔积液治疗不同于其他年龄段的患者。本文采用表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)治疗老年恶性胸腔、心包积液,取得了较好效果。     

热疗联合重组人血管内皮抑素胸腔注射治疗老年恶性胸腔积液36例

胸腔积液是恶性肿瘤常见的并发症,给患者造成极大痛苦,生活质量明显下降,甚至危及生命.尤其是老年患者,心肺功能减低,大量胸腔积液压迫肺组织,使有效呼吸面积减少,导致患者呼吸困难、活动受限,甚至呼吸衰竭死亡.恶性肿瘤导致的胸腔积液总体的治疗方法大致相同,均为排液后腔内药物注射,但白介素、化疗药、中药剂化疗药物等药物副作用较大,老年患者因身体一般状态差,各个器官功能相对减弱,故对于药物毒副作用的耐受性差.故针对老年恶性胸腔积液低毒,若有效治疗可以改善症状,提高患者生存质量,延长患者生存期.重组人血管内皮抑素是我国自主研发的靶向抗肿瘤新药,具有抗血管生成作用.本文拟回顾分析微波热疗与胸腔内注射重组人血管内皮抑素联合治疗对老年患者恶性胸腔积液的疗效,为其临床应用提供依据.     

恶性胸腔积液的治疗进展

恶性胸腔积液的治疗进展华西医科大学附属第一医院内科李为民综述陈文彬审校恶性胸腔积液是晚期恶性肿瘤的常见并发症，肺癌和乳腺癌是恶性胸腔积液的主要病因。晚期恶性肿瘤并发恶性胸腔积液时，大多数患者的生存率仍在６个月以上，且部分恶性淋巴瘤、生殖细胞肿瘤并发的...     

改良胸腔积液引流方法治疗恶性胸腔积液

我院内科自2005年始采用改良胸腔积液引流方法治疗恶性胸腔积液病人，获得良好疗效。     

Therapeutic effects of recombinant human endostatin adenovirus in a mouse model of malignant pleural effusion

Purpose  Malignant pleural effusion (MPE) is a common clinical problem in patients with advanced cancer. Evidence suggests that tumor-mediated angiogenesis and enhanced vascular permeability in the pleural wall are due to high levels of vascular endothelial growth factor (VEGF), which plays an important role in the pathogenesis of MPE. The present study was designed to test whether the recombinant adenovirus-mediated delivery of human endostatin (Ad-hEndo), one of the potent inhibitors of angiogenesis, would inhibit the formation and progression of MPE. Methods  We developed a novel mouse model of MPE by injecting Lewis lung carcinoma (LLC) cells directly into pleural cavity of C57BL/6 mice. To evaluate the therapeutic effects of endostatin in this MPE model, we injected the Ad-hEndo into the pleural cavity of MPE-bearing mice three times with the 3-day interval. Results  We found that this treatment resulted in significant reduction in pleural effusion volume, the number of pleural tumor foci, microvessel density, and vascular permeability, while it significantly prolonged the survival time. In addition, VEGF level of MPE in the group administered with the Ad-hEndo was obviously decreased as compared with that in the two control groups administered with null-adenovirus (Ad-null) or normal saline. Conclusions  Our work provides a rationale for future studies toward evaluating the effectiveness of the adenovirus-based endostatin therapy for MPE. F. Fang, P. Chen and X. Wu have equally contributed to this work.     

WIF-1 promoter region hypermethylation as an adjuvant diagnostic marker for non-small cell lung cancer-related malignant pleural effusions

Purpose  Malignant pleural effusion is an important staging criterion in non-small cell lung cancer (NSCLC). Although cytologic examination remains the major diagnostic tool for NSCLC-related malignant pleural effusion, sometimes other invasive methods maybe required. Aberrant activation of Wnt signaling pathway due to Wnt inhibitory factor-1 (WIF-1) promoter region hypermethylation is common in NSCLC, and can be specifically detected by methylation-specific polymerase chain reaction (MSP). We hypothesized that WIF-1 promoter region MSP can be used to improve the diagnostic yield of NSCLC-related malignant pleural effusion. Methods  We performed WIF-1 promoter region MSP in 36 definite malignant pleural effusions from consecutive NSCLC patients and 35 pleural effusion specimens of benign origin. Pleural effusion cells were collected for DNA extraction. After bisulfite treatment, DNA was amplified by methylation-specific and unmethylation-specific primers, respectively, to identify the methylation status of WIF-1 promoter region. Results  The results of WIF-1 promoter region MSP were positive in 25 (69.4%) of 36 NSCLC patients with malignant pleural effusion. In addition, the results of WIF-1 promoter region MSP were negative in all 35 patients with pleural effusion of benign origin. The age, gender, and smoking status of patients were not correlated with the methylation status of WIF-1 promoter region in NSCLC-related malignant pleural effusion. Conclusions  WIF-1 promoter region MSP might be used as an adjuvant tool to complement cytologic examination for the diagnosis of NSCLC-related malignant pleural effusion. T.-M. Yang and S.-W. Leu are the first authors and contributed equally.     

非小细胞肺癌性恶性胸腔积液研究进展

恶性胸腔积液（malignantpleuraleffusion,MPE）约占临床所有胸腔积液的40％,多数MPE患者症状严重,预后差,总体生存期3～6个月,且现有治疗效果不佳。MPE的病因复杂,主要为肿瘤对胸膜的直接侵袭和转移。肺癌是MPE最常见的病因,约15％晚期非小细胞肺癌会发生MPE。本文将综述非小细胞肺癌所致MPE的发生机制,并详细介绍MPE诊疗和预后进展。     

Management of recurrent malignant pleural effusions with a tunneled indwelling pleural catheter

In this review, we report on the use of indwelling pleural catheters in the treatment of malignant pleural effusions. We describe the most commonly used catheter. Also, treatment with indwelling pleural catheters as compared to talc pleurodesis is reviewed. A comparison of efficacy, costs, effects on quality of life, and complications is made. Only one randomized controlled trial comparing the two is available up to date, but several are underway. We conclude that treatment for malignant pleural effusions with indwelling pleural catheters is a save, cost-effective, and patient-friendly method, with low complication rates.     

胸腔内注入顺铂联合滑石粉治疗恶性胸腔积液疗效比较

目的 探讨胸腔内注入顺铂（DDP）联合滑石粉治疗恶性胸腔积液的疗效。方法 病理确诊的恶性胸腔积液58例,经胸腔插管引流术排除胸水后,随机分为二组,开始均胸腔内注入80mg顺铂,治疗组（A组,30例）1周后重复一次,并注入3％滑石粉混悬液100ml;对照组（B组,28例）1周后使重复一次,观察疗效、生活质量、生存率及毒副反应。结果 治疗组总有效率80％,较对照组46％,差异有显著性（P〈O．01）。治疗组0．5、1年的生存率分别高于对照组,差异有显著性。结论 胸腔内联合注入DDP和滑石粉治疗恶性胸腔积液是一种有效的、经济的、副反应少的方法。     

Prolonged pleural catheters in the management of pleural effusions due to breast cancer

Background

Breast cancer is the second most common etiologic cause in malignant pleural effusions (MPE). The aim of this study was to investigate the efficacy of long term pleural catheters in inducing self sclerosis in pleural effusions of breast cancer patients.

Methods

In this study, 26 patients with breast cancer relapleural effusions that occurred between January 2011 and July 2013, who were considered not to undergo any other treatments and managed with prolonged pleural catheters (Jackson-Pratt silicone flat drain), were retrospectively analyzed. Thirty pleural catheters were inserted in 26 patients. All patients were female, mean age was 52 (range, 37-66) years old. Drainage over 1,500 mL per day was not allowed in order to avoid a lung edema. The catheters were removed in patients who had restoration of lung expansion and drainage under 50 mL/day.

Results

The histologic subtypes in pleural effusions were invasive ductal carcinoma in 18 patients, ductal carcinoma in situ in 4, invasive lobular carcinoma in 2, tubular carcinoma in 1, and medullary carcinoma in 1. Three of the 26 patients underwent bilateral catheter insertion, and one patient underwent a reinsertion of the catheter into the same hemithorax due to a recurrence. The catheters were retained for a mean period of 18 days (range, 11-38 days). In one patient with invasive ductal carcinoma and paramalignant pleural effusion (PMPE) (3.8%), a recurrent pleural effusion was seen 34 days after removal of the catheter. There were no complications. One patient died while the catheter was in place.

Conclusions

Prolonged catheters for the management of pleural effusions in selected patients have become more popular than other treatment alternatives due to a shorter length of stay and lower costs. We recommend the use of Jackson Pratt (JP) silicone flat drains which in our opinion provide effective pleurodesis in addition to easy application in recurrent effusions caused by breast cancer.