胸腔热灌注化疗治疗癌性胸腔积液的护理研究

目的 探讨胸腔内热灌注化疗治疗恶性胸腔积液的疗效及毒副作用,总结护理经验.方法 中心静脉导管胸腔置管引流彻底后,将顺铂(DDP)加热到42℃,胸腔内灌注.结果 完全缓解(CR)14例,部分缓解(PR) 5例,稳定(SD) 1例,无效(PD) 2例,总有效率(RR)为86.4%.结论 护士在配合热灌注治疗中除应详细了解热灌注机的工作原理及操作步骤,熟练配合治疗医生进行操作外,应密切观察患者的病情,正确评估患者,及时发现不良反应、并发症,并能够及时对症处理.     

胸腔热灌注化疗治疗恶性胸腔积液的疗效观察

目的 探讨胸腔内热灌注化疗治疗恶性胸腔积液的疗效及毒副反应.方法 中心静脉导管胸腔置管引流彻底后,将DDP加热到42℃,胸腔内灌注.结果 显效(CR)14例,有效(PR)5例,稳定(SD)1例,无效(PD)2例,总有效率(RR)86.4%.结论 在观察胸腔积液的变化、原发灶的变化、生活质量的改善以及不良反应方面,总结出胸腔热灌注化疗治疗恶性胸腔积液,方法 便于掌握,费用低廉,疗效确切.     

胸腔热灌注化疗研究进展

1热疗基本常识1.1热疗分类按加热方法分类:①热水;②红外线;③电阻丝;④低压直流/电化学;⑤电磁波,射频,微波;⑥高能聚焦超声[1]。按部位分:全身热疗和局部热疗:全身热疗不良反应较大,患者难以耐受,应用范围较局限。方法:①体外循环血液加热法;②体外红外线加热仓法;③微波体外加热法;④温泉浴法;⑤蜡疗法。局部热疗方法简便,副作用较小,患者容易接受。包括腔内热灌注治疗、组织间热疗、体外局部热疗。其中腔内热灌注化疗:适用于胸、腹、盆腔的广泛转移的小病灶及亚临床病灶或术前、术后的配合治疗。热疗设备:目前我国有微波热疗、超声波聚…     

持续热灌注化疗对老年恶性胸腔积液患者血管内皮生长因子及免疫功能的影响

目的探讨持续热灌注化疗对老年恶性胸腔积液患者血管内皮生长因子(VEGF)及免疫功能的影响。方法选择非小细胞肺癌伴恶性胸腔积液的84例患者为研究对象,采用随机数字表法分为热灌注组和常规灌注组各42例。热灌注组接受持续热灌注化疗,常规灌注组接受常规灌注化疗,比较两组患者胸水中血管内皮生长因子、血清中免疫球蛋白含量、治疗效果及不良反应。结果热灌注组有效率(85.71%)明显高于常规灌注组(66.67%,χ~2=4.200,P0.05)。热灌注组患者胸水中血管内皮生长因子VEGFA、VEGFB、VEGFC的含量显著低于常规灌注组(t=7.183~8.912,P0.05),血清中免疫球蛋白Ig G、Ig M、Ig A的含量明显高于常规灌注组(t=6.658~7.383,P0.05);两组不良反应比较无统计学意义(76.19%vs 64.29%)(χ~2=1.424,P0.05)。结论持续热灌注化疗有助于抑制老年恶性胸腔积液患者VEGF的生成,改善免疫功能,提高疗效。     

持续循环胸腔热灌注顺铂治疗恶性胸腔积液的疗效观察

正恶性胸腔积液(malignant pleural effusion,MPE)为肺恶性肿瘤最常见的并发症,大量胸腔积液对心脏、肺等产生物理性挤压,使患者出现明显的呼吸困难、胸闷、气短等临床症状,严重影响患者生活质量且病情危重,为疾病预后不良的重要指征[1-2]。目前临床上对于MPE的主要治疗方法为治疗性胸腔穿刺、胸腔闭式引流、胸腔引流后灌注化疗等,但治疗效果较差。我科采用持续循环胸腔热灌注顺铂治疗非小细胞肺癌导致的MPE取得了一定的临床疗效。     

持续热灌注化疗对老年恶性胸腔积液患者肿瘤标志物的影响

目的探讨持续热灌注化疗对老年恶性胸腔积液患者肿瘤标志物[癌胚抗原(CEA)、糖类抗原(CA)125、CA153、CA199、细胞角质素片段抗原(CYFRA)21-1、神经元特异性烯醇化酶(NSE)]的影响。方法按随机数字表法将老年恶性胸腔积液患者88例分为两组,给予对照组44例常规灌注化疗,给予研究组44例持续热灌注化疗。连续治疗1个疗程后,比较两组临床疗效、肿瘤标志物变化及生活质量[Karnofsky功能状态(KPS)评分]。结果研究组治疗总有效率为88.64%(39/44),明显高于对照组的68.18%(30/44),差异有统计学意义(P<0.05);研究组CEA、CA125、CA153、CA199、CYFRA21-1、NSE水平明显低于对照组,差异有统计学意义(P<0.05);研究组KPS评分为(76.42±3.15)分,明显高于对照组KPS评分[(66.26±4.52)分],差异有统计学意义(P<0.05)。结论对老年恶性胸腔积液患者实施持续热灌注化疗,能有效降低肿瘤标志物水平,减轻患者病情,提高临床疗效,改善生活质量。     

胸腔内置管化疗治疗恶性胸水的体会

恶性胸水是晚期肿瘤的常见并发症,其特点是生长迅速,呈血性和大量积液,严重影响心肺功能,临床治疗比较困难,我们自2002年9月至2005年1月采用胸腔置管引流并胸腔内注射化疗药物治疗恶性胸水38例取得较好的效果。现报告如下。1资料与方法1.1一般资料本组恶性胸水患者38例,男27例,女11例年龄26～78岁,平均56.4岁。所有患者均经细胞学或/和病理学确诊,其中肺癌19例,包括腺癌16例,鳞癌2例,小细胞癌1例;乳腺癌10例;胃肠道肿瘤5例;纵隔肿瘤4例。胸腔积液均经X线和/或B超证实,均为中等量以上积液。1.2方法选用美国Arrow公司生产的单腔中心静脉导管…     

热疗联合胸腔内化疗治疗恶性胸腔积液的临床研究

目的观察热疗联合胸腔内化疗治疗癌性胸腔积液的疗效。方法 63例确诊为癌性胸腔积液患者随机分两组:对照组31例接受中心静脉置管抽液后单纯胸腔内灌注化疗药物;研究组32例给予置管抽液后灌注化疗药物治疗及热疗。比较两组患者的临床症状改善状况、生活质量及不良反应。结果研究组胸水治疗有效率明显高于对照组(87.5%vs 64.5%,P0.05),生活质量的改善率亦明显好于对照组(93.8%vs66.7%,P0.01)。两组毒性反应率比较无统计学差异(P0.05)。结论热疗及胸腔灌注化疗联合治疗癌性胸腔积液的疗效显著,不良反应未增加。     

晚期肺癌胸腔热灌注化疗对心脏影响的观察

目的 观察胸腔热灌注化疗对晚期肺癌患者心脏状况的影响。方法 选取2014年8月至2019年8月病理确诊肺癌的69例胸腔热灌注化疗的患者,男性42例（60.8%）,女27例（39.8%）;平均年龄（66±15）岁。在胸腔热灌注化疗治疗前、治疗60分钟及治疗后24小时检测平均动脉压、心电图、血清脑钠肽（brain natriuretic peptide, BNP）和肌钙蛋白（cTnT）等指标。结果 当胸腔热灌注化疗治疗60分钟时,患者出现了不同程度的胸闷、心?、胸痛等症状,患者血清BNP水平较前显著增高（P<0.05）,出现窦性心动过速和ST—T改变的比率较治疗前明显增加（P值均<0.05）。化疗后24小时上述指标均基本恢复到化疗前水平,且症状逐渐消失。化疗期间患者平均动脉压和cTnT无明显变化（P>0.05）,亦无严重的心血管事件发生。结论 对晚期肺癌患者应用胸腔热灌注化疗,不会对心脏造成较大的损伤,但应该对患者做好心脏功能评估和预防措施。     

腹腔热灌注化疗联合全身化疗治疗老年癌性腹水的临床研究

目的研究草酸铂腹腔热灌注联合5-氟脲嘧啶/亚叶酸钙(5-FU/LV)方案治疗老年癌性腹水的疗效及不良反应。方法40例癌性腹水病人,随机分为2组,治疗组21例采用草酸铂腹腔热灌注。灌注后行腹腔深部热疗,使其温度控制于41℃~43℃,持续90min。腹腔化疗后第2天起予以5-FU/LV方案行全身化疗。对照组19例单用顺铂腹腔灌注化疗,并行5-FU/LV方案行全身化疗。2周期后评价疗效。结果治疗组和对照组有效率分别为71.4%和36.8%(P<0.05)。主要不良反应为急性腹痛、恶心、呕吐以及骨髓抑制,2组间无显著性差异。结论草酸铂腹腔热灌注化疗联合5-FU/LV方案治疗老年性癌性腹水效果较好,且不良反应可耐受。     

The efficacy and safety of intrapleural hyperthermic perfusion in patients with malignant pleural effusion undergoing video-assisted thoracic surgery: a single-arm clinical trial

BackgroundPatients with malignant pleural effusion (MPE) are usually treated with an indwelling pleural catheter (IPC) or pleurodesis. However, most do not achieve a satisfactory control rate of pleural effusion and have poor prognosis. Distilled water has cytocidal effects of hypotonic shock and can result in the lysis of cancer cells which was used in surgery to eradicate cancer cells. However, there is no study focusing on the efficacy of intrapleural hyperthemic perfusion for MPE under video-assisted thoracoscopic surgery (VATS). This study explored the efficacy and safety of intrapleural hyperthermic perfusion (IHP) with distilled water in patients with MPE.MethodsIn this retrospective, single-arm trial, patients admitted to department of cardiothoracic surgery of Taizhou hospital and diagnosed with MPE caused by non-small cell lung cancer from January 2014 and December 2018 were included. The clinical characteristics including age, gender smoking history, Karnofsky score, volume of pleural effusion, TNM cancer stage, pathology, genetic test of patients were collected. Patients were treated with hyperthermic perfusion. The pleural cavity was perfused with 43.0 ℃ distilled water for 60 minutes under video-assisted thoracic surgery (VATS). The efficacy of treatment was defined as follows: (I) complete remission (CR; no recurrence of pleural effusion after IHP for at least four weeks); (II) partial remission (PR; pleural effusion was decreased by 50% and the condition lasted for 4 weeks; or (III) no remission (NR; no decrease in pleural effusion). Kaplan-Meier method with a log-rank test was used for survival analysis. Cox proportional hazards regression models were applied to perform univariate and multivariate analysesResultsFrom January 2014 through December 2018, 30 patients with MPE caused by non-small cell lung cancer (NSCLC) were treated with hyperthermic perfusion. There were no serious reportable clinical complications associated with the procedure. The response rate was 96.7%, with 63.3% experiencing PR and 33.3% achieving CR. The overall survival (OS) ranged from 2 to 46 months. The median survival was 12 months.ConclusionsIHP proved to be a feasible and safe strategy for patients with MPE in our study but it still needs to be verified with a larger, prospective and randomized trial in the future.     

高聚生联合腔内化疗对恶性胸水的疗效

目的 观察高聚生联合胸腔内化疗治疗恶性胸水的疗效。方法 尽量抽尽胸水后，以高聚生(HASL)2000单位 顺铂60mg，缓慢注入胸腔，2h内每20—30min变动体值一次，与单用顺铂对照。结果 治疗组RR为87．5％(28／32)，对照组为58．3％，(14／24)，两组有显性差异(P＜0．01)。结论 高聚生是一种新型有希望的生物反应调节剂，与化疗药物有协同作用，能刺激增加患的免疫力，减轻因白细胞降低而引起的的副反应。     

Current concepts in chemotherapy for malignant pleural mesothelioma

Objectives: The aim of this study was to provide an overview of the most active single agents and combination regimens in malignant pleural mesothelioma (MPM). Data Source: Literature on English‐language trials in humans was searched on Medline until October 2007. Indexing terms were malignant pleural mesothelioma and chemotherapy. Study Selections: Trials with ≥15 patients and with data on activity were included. Results: Detorubicin and pirarubicin have response rates (RRs) of 22%–26%, epirubicin of 5%–15%, docetaxel of 5%–23% and vinorelbine of 24%. Other active agents were ifosfamide (3%–24%) and mitomycin C (21%). Carboplatin and cisplatin have an overall RR of 11% in three studies and 17% in four studies, respectively. Antimetabolites were active, including methotrexate (37%), raltitrexed (21%), edatrexate (16%–25%) and pemetrexed (15%). With respect to combination chemotherapy regimens, only cisplatin with either pemetrexed or raltitrexed has been compared with other substances, in both cases to cisplatin monotherapy. Both showed a survival advantage, which was statistically significant in the trial including pemetrexed, suggesting that chemotherapy improved survival in MPM. No studies have compared chemotherapy with the best supportive care alone, and none has compared different combination chemotherapy regimens with each other. Conclusions: A number of single‐agent cytotoxics posess moderate activity against MPM. A number of platinum‐based combination chemotherapy regimens show similar activities, but none has been compared with another combination. Cisplatin with either raltitrexed or pemetrexed has improved survival compared with cisplatin alone, and may be used as a reference treatment in randomized trials. Targeted agents should be explored in order to further improve the outcome. Please cite this paper as: Sørensen JB. Current concepts in chemotherapy for malignant pleural mesothelioma. The Clinical Respiratory Journal 2008; 2: 74–79.     

结直肠癌术后腹腔热灌注化疗的护理

结直肠癌是我国最常见的恶性肿瘤之一,随着诊疗技术的不断进步,其5年生存率在不断提高。然而,仍有部分患者确诊时已有腹腔种植转移或根治性术后很快出现腹腔种植转移,其5年生存率极差。目前,已有临床研究证实细胞减瘤术加腹腔热灌注化疗是治疗结直肠癌腹腔种植转移的有效方法,能有效提高结直肠癌患者的生活质量和延长生存期。本文就此对结直肠癌术后应用腹腔热灌注化疗的护理经验进行综述,为临床护理提供依据,改善患者的治疗效果,全面提高护理质量。     

热灌注基础上腹腔内贝伐珠单抗联合化疗治疗恶性腹水的临床观察

目的观察在热灌注的基础上腹腔内注射贝伐珠单抗(安维汀)联合腔内化疗治疗恶性腹水患者的疗效和安全性。方法 57例恶性腹水患者在热灌注的基础上随机分为腔内贝伐珠单抗联合化疗治疗组(治疗组)和腔内单纯化疗治疗组(对照组)。治疗前均先排尽腹水,以43～45.0℃灭菌0.9%生理盐水注入腹腔,持续有效循环40 min以上,排尽灌注液后治疗组在腹腔内注入贝伐珠单抗300 mg和氟尿嘧啶1 g。对照组除不加入贝伐珠单抗外,其余同治疗组。结果在可评价的57例患者中,治疗组总有效率为85.71%,对照组58.62%,P<0.05。全组患者耐受良好,无严重不良反应。结论热灌注基础上腹腔内贝伐珠单抗联合化疗治疗恶性腹水优于腔内单纯化疗且安全可靠。     

结核性胸腔积液抽液前后血气动态变化分析

目的了解结核性胸腔积液患者在抽液前后的血气变化情况?方法对40例单侧结核性胸腔积液患者抽液前后不同时间的血气和P(A-a)O₂进行检测?结果抽液前PaO₂及PaCO₂均降低,而P(A a)O₂增大;术后PaO₂升高,P(A-a)O₂逐渐变小,PaCO₂无明显变化?结论结核性胸腔积液可导致低氧血症及慢性呼吸性碱中毒,抽液能改变低氧血症。     

Current status and future strategies of cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis

This article is to offer a concise review on the use of cytoreductive surgery （CRS） plus intraperitoneal hyperthermic chemotherapy （IPHC） for the treatment of peritoneal carcinomatosis （PC）. Traditionally, PC was treated with systemic chemotherapy alone with very poor response and a median survival of less than 6 too. With the establishment of several phase Ⅱ studies, a new trend has been developed toward the use of CRS plus IPHC as a standard method for treating selected patients with PC, in whom sufficient cytoreduction could be achieved. In spite of the need for more high quality phase Ⅲ studies, there is now a consensus among many surgical oncology experts throughout the world about the use of this new treatment strategy as standard care for colorectal cancer patients with PC. This review summarizes the current status and possible progress in future.     

Chinese expert consensus on cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancies

Locoregional spread of abdominopelvic malignant tumors frequently results in peritoneal carcinomatosis(PC). The prognosis of PC patients treated by conventional systemic chemotherapy is poor, with a median survival of 6 mo. However, over the past three decades, an integrated treatment strategy of cytoreductive surgery(CRS) + hyperthermic intraperitoneal chemotherapy(HIPEC) has been developed by the pioneering oncologists, with proved efficacy and safety in selected patients. Supported by several lines of clinical evidence from phases Ⅰ, Ⅱ and Ⅲ clinical trials, CRS + HIPEC has been regarded as the standard treatment for selected patients with PC in many established cancer centers worldwide. In China, an expert consensus on CRS + HIPEC has been reached by the leading surgical and medical oncologists, under the framework of the China Anti-Cancer Association. This expert consensus has summarized the progress in PC clinical studies and systematically evaluated the CRS + HIPEC procedures in China as well as across the world, so as to lay the foundation for formulating PC treatment guidelines specific to the national conditions of China.