经皮穿刺置管引流及胸腔内注药治疗恶性胸液

目的 探讨胸腔闭式引流术与胞必佳治疗恶性胸腔积液的临床疗效。方法 对42例恶性胸腔积液患采用经皮穿刺胸腔内置管持续引流，肺完全复张后予胸腔内注入胞必佳。结果 42例恶性胸腔积液患9例完全缓解，26例部分缓解，7例无效，有效率83．3％。结论 该法治疗恶性胸腔积液具有操作方便、安全，患痛苦少等优点，明显改善生活质量，有一定疗效。     

细管胸腔闭式引流并腔内注药治疗恶性胸水(附32例分析)

目的 探讨细管胸腔闭式引流术并腔内注药治疗恶性胸水的临床疗效。方法 对有临床确诊的恶性胸腔积液患，经B超胸水定位后，采用细套管针穿刺，细引流管引流，积液引流干净后胸腔内注入顺铂60mg，高聚生5000μ，每周2次。结果 32例恶性胸腔积液患显效16例，有效12例，无效4例，总有效率87．5％。结论 该方法所用药品价廉，患痛苦小，避免了粗管引流创伤大及引流管堵塞现象，显提高了临床疗效。     

腔内注入尿激酶联合化疗治疗多房性包裹性恶性胸腔积液8例报告

临床中多房性包裹性恶性胸腔积液治疗较为棘手，近年来胸腔注入尿激酶治疗良性包裹性胸腔积液取得了较好疗效，尚未见有尿激酶用于恶性包裹性胸腔积液的报道。我们对8例多房性包裹性恶性胸腔积液患采用胸腔注入尿激酶联合胸腔化疗取得了较好的疗效，现报告如下：     

胸腔置管引流灌注化疗治疗恶性胸腔积液

目的观察胸腔灌注化疗治疗恶性胸腔积液的疗效及副作用。方法采用经皮胸腔内埋置中心静脉导管，引流积液并注入顺铂（DDP）、依托泊苷（VP16）治疗34例恶性胸腔积液。结果治疗恶性胸腔积液有效率为85％，副作用主要为恶心、呕吐、白细胞减少。结论经皮胸腔内埋置中心静脉导管化疗是一种安全有效的方法。     

重组改构的人肿瘤坏死因子治疗恶性胸腔积液

背景与目的：恶性胸腔积液是影响中晚期肺癌和乳腺癌患者生存质量和生存时间的一个重要因素，如何有效控制恶性胸腔积液是目前迫切需要解决的问题。本研究探讨了重组改构的人肿瘤坏死因子（rmhTNF，纳科思）治疗恶性胸腔积液的疗效和毒副反应。方法：45例中至大量胸腔积液患者尽量排尽胸腔积液后，注入单药rmhTNF 15Mu，每周3次。结果：45例恶性胸腔积液中，CR16、例，PR25例，无效4例，总有效率91．1％。生活质量提高并完成化疗者32例，1例因病期较晚死亡。结论：rmhTNF局部治疗恶性胸腹水疗效可靠，生活质量提高，无明显毒副作用，是治疗恶性胸腹水的有效手段之一，尤其是不能耐受全身静脉化疗的患者。     

红霉素联合顺铂治疗恶性胸腔积液21例临床观察

目的：探讨恶性胸腔积液的治疗方法。方法：经B超定位，行胸腔穿刺持续引流，待胸水放尽后，将DDP60～80mg注入胸腔；2天后，待胸水放尽后，用5％葡萄糖溶液20 ml将红霉素1～1.5g溶解后注入胸腔；24小时后若积液量大于200 ml，应重复用红霉素注入胸腔，最多重复3次。结果：21例患者中显效8例，有效10例；随访6个月，18例有效者未见胸腔积液复发。结论：红霉素联合顺铂治疗恶性胸腔积液患者，疗效确切，是一种较好的治疗方法。     

腔内注药治疗肺癌与其他恶性肿瘤伴胸腔积液的疗效比较

目的 比较肺癌胸腔积液与其它恶性胸腔积液的疗效。方法 将病例分成肺癌组和非肺癌组，行腔内注药治疗后分别评价其疗效。结果 肺癌组179例中显效36例，有效79例，无效64例。非肺癌组96例中显效31例，有效44例，无效21例。结论 腔内注药治疗恶性胸腔积液，其它恶性胸腔积液疗效明显优于肺癌胸腔积液的疗效。胸腔闭式引流后注药能显著提高恶性胸腔积液的疗效。     

鸦胆子油乳剂治疗恶性胸腔积液25例临床分析

目的观察鸦胆子油乳剂对恶性胸腔积液的疗效.方法对25例恶性胸腔积液患者的疗效进行评价分析.结果 25例患者治愈16例,治愈率64.0%;好转5例(20.0%);无效4例(16.0%).结论鸦胆子油乳剂治疗恶性胸腔积液治愈率高,不良反应小,适合临床应用.     

康莱特治疗恶性胸腔积液的临床研究

目的 研究康莱特治疗恶性胸腔积液的临床应用价值。方法 60例恶性胸腔积液的患随机分为治疗组和对照组各30例，治疗组采用康莱特胸腔灌注，对照组采用顺铂胸腔灌注。结果 治疗组的疗效、治疗前后的免疫功能、生存期及毒副反应均明显优于对照组。结论 康莱特能有效地控制恶性胸腔积液，提高免疫力，延长生存期，改善生活质量。     

不同药物胸腔内灌注治疗恶性胸腔积液的疗效比较

目的　通过用不同药物胸腔内灌注治疗恶性胸腔积液的临床疗效观察 ,探讨恶性胸腔积液的最佳治疗方法。方法　 14 1例由组织学或细胞学诊断的恶性胸腔积液患者非随机分成DDP(顺铂 ) +VP16 (足叶乙甙 )组 ,DDP +HAS(高聚金葡素 )组 ,HAS组和DDP组四组。将胸水抽尽以后 ,胸腔内分别注入上述药物以观察疗效。结果　各组有效率分别为 90 2 %、94 6 %、85 3 %和 6 2 1% ,中位缓解期分别为 15周、18周、14周和 12周 ,DDP +HAS联合用药组的疗效最好 ,DDP +VP16联合用药组的疗效次之 ,而单用生物反应调节剂HAS组的疗效稍差 ,但经统计学处理三者间的差异无显著性 (P >0 0 5 ) ;而联合用药组及单用HAS组的疗效均明显优于单药DDP组 (P <0 0 5 )。结论　根据病人的身体状况及经济条件 ,选择应用DDP与HAS联合、DDP与VP16联合及用HAS是治疗恶性胸腔积液较好的方法 ,而单用化疗药物DDP效果不佳。     

细管胸腔闭式引流与常规胸腔穿刺控制恶性胸腔积液随机对照研究

背景与目的恶性胸腔积液是晚期恶性肿瘤常见的一个问题。治疗多为姑息性，常采用胸腔穿刺或粗管闭式引流。粗管闭式引流损伤大，易感染，患者活动受限。本研究的目的是观察细孔径导管胸腔闭式引流后注药治疗恶性胸腔积液的临床疗效。方法将恶性胸腔积液患者随机分成两组，分别进行中心静脉导管闭式引流和常规胸腔穿刺，并均于胸腔内注入顺铂（cisplatin，DDP）和白介素-2（interleukin-2，IL-2）。结果细孔径导管闭式引流组胸腔积液的控制率为80．00％，明显优于常规穿刺组的36．67％（P〈0．01）。细孔径导管闭式引流组的不良反应少于常规穿刺组。结论应用细孔径导管装置引流恶性胸腔积液操作安全、简便，能最大限度地排净胸腔积液，对控制癌性胸腔积液有较好的疗效，能显著改善患者生活质量。     

Pharmacokinetics of intrapleural cisplatin for the treatment of malignant pleural effusions

We determined the toxicity and pharmacokinetics of high-dose intrapleural cisplatin (CDDP) as a treatment of malignant pleural effusions (MPE). Fourteen patients with MPE were enrolled in this study. After complete drainage of the fluid, a catheter was inserted into the pleural cavity during a thoracoscopy. CDDP (300 mg) was administered via the catheter in a 6-h infusion. Peak levels, the areas under the concentration curve (AUC), and drug half-lives were measured in pleural fluid and plasma samples collected at 0 (baseline), 6, and 24 h as well as 4, 14, and 21 days after intrapleural administration. The dosage of CDDP ranged from 153 to 203 mg/m2. The time interval between infusion was prolonged until a maximum of 109 days. Only 7/40 infusions were associated with adverse effects in 4 patients (18%). Residual concentrations in pleural fluid (0.66+/-0.07 microgram /ml) were three-fold higher than in plasma (0.13+/-0.07 microgram/ml). In pleural fluid, maximal concentration (Cmax) varied from 19 to 900 microgram/ml and in plasma from 0.34 to 3.65 microgram/ml. AUC in plasma during the three courses was 112+/-49 microgram/ml/d. The T1/2 was 31+/-33 days higher than that previously reported after intravenous administration (8-15 days). Although intrapleural CDDP has the potential advantage of treating the underlying malignancy in addition to controlling the malignant effusion with a good tolerance, it cannot be recommended for the standard control of malignant pleural effusion. Indeed we observed a great variability of intrapleural CDDP concentration depending on the extent of pleural invasion and plasma diffusion. Further studies are needed to determine the value of high-dose intrapleural CDDP for the treatment of MPE.     

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.      

短小棒状杆菌菌苗治疗恶性胸腔积液临床观察

[目的]评价短小棒状杆菌菌苗治疗恶性胸腔积液的疗效和毒性。[方法]应用短小棒状杆菌菌苗胸腔内给药治疗46例恶性胸腔积液患者。[结果]有效率76．1％，其中完全缓解率47．8％；毒副反应主要为发热和胸痛，预防性用药后可控制。[结论]短小棒状杆菌菌苗治疗恶性胸腔积液疗效肯定，毒副反应可控制，充分引流、联合全身化疗可提高疗效。     

Prospective randomized trial of intrapleural bleomycin versus interferon alfa-2b via ultrasound-guided small-bore chest tube in the palliative treatment of malignant pleural effusions.

PURPOSE: To compare bleomycin pleurodesis and immunotherapy with intrapleural interferon alfa-2b (IFN) in the palliation of malignant pleural effusions. PATIENTS AND METHODS: One hundred sixty patients with rapidly recurrent malignant pleural effusion were randomly assigned to intrapleural bleomycin (83 patients) or IFN (77 patients). A 9-French intrapleural catheter was placed under sonographic guidance, and pleural effusion was completely drained before starting the treatment. Bleomycin 0.75 mg/kg was administered as a single dose. An additional dose was given if daily fluid output did not drop to less than 100 mL/d within 3 days. IFN 1 million units/10 kg was administered for six courses at 4-day intervals. Thirty-day and long-term responses were evaluated under the intention-to-treat principle. RESULTS: Thirty-day response was 84.3% in the bleomycin arm and 62.3% in IFN arm (P =.002). Median time to progression was 93 days (range, 12 to 395 days) in bleomycin group, and 59 days (range, 7 to 292 days) in the IFN group (P <.001). Median survival was 96 days (range, 15 to 395) and 85 days (range, 16 to 292) in the bleomycin and IFN groups, respectively. Twenty-three patients received two doses of bleomycin, as their daily fluid output remained higher than 100 mL after the first dose. Thirteen of them had complete response, which lasted until death. CONCLUSION: Intrapleural bleomycin is more effective than IFN and is a valid option for the palliative treatment of massive, rapidly recurrent malignant pleural effusions. The administration of a second dose of bleomycin to patients not responding to the first one can remarkably improve the overall outcome of the treatment.     

Small bore catheter drainage and sclerotherapy for malignant pleural effusions

The accumulation of large amounts of fluid in the pleural space is a common sequela of disseminated carcinomatosis. Traditional management has included therapeutic thoracentesis or the placement of a large bore chest tube for drainage with the subsequent installation of a sclerosing agent in an attempt to achieve pleural symphysis. An evaluation of all patients treated in this manner during a 4-year period was undertaken to assess the degree of success obtained with a large bore standard chest tube versus a small pigtail catheter. A study group consisting of 20 patients with a total of 24 pleural effusions was treated with drainage and sclerotherapy. In this group, eight of 13 effusions were adequately treated with pigtail catheter drainage and sclerotherapy, compared with four of 11 effusions adequately treated with standard chest tube drainage and sclerotherapy. Although the numbers are small, it appears that pigtail catheter drainage and sclerosis is at least as successful as the more traditional drainage with the standard chest tube.     

自体不成熟树突状细胞胸腔内注射治疗化疗耐药的肿瘤患者恶性胸腔积液

目的:观察体外扩增的不成熟树突状细胞(dendritic cells,DC)胸腔内注射对恶性胸腔积液的疗效和安全性。方法:从6例对化疗耐药的恶性胸腔积液患者采集外周血单个核细胞,体外细胞因子诱导培养获得不成熟DC,每4周患者胸腔内注射DC(5~10)×107个,连续3次为一疗程,观察治疗后患者胸腔积液的变化及治疗的不良反应,流式细胞仪检测胸水中T细胞、NK细胞亚群。结果:总体疗效为:CR 2例,PR 1例,SD 1例,PD 2例,有效率为50%(3/6),获益率(CR+PR+SD)为66.7%。2例CR均为肾癌患者,缓解时间达26周和147周;3例肺癌患者中1例PR、1例SD及1例PD;1例恶性胸膜间皮瘤PD;治疗中无严重不良反应发生。DC治疗后6例患者胸水中的T细胞百分率均较治疗前上升,但差异无统计学意义;NK细胞百分率较治疗前明显上升(P<0.05)。结论:采用无抗原加载的自体不成熟DC胸腔内注射治疗恶性胸腔积液的疗效肯定,可能主要是通过NK细胞介导,是一种安全、有效的治疗方法。     

Pharmacokinetics of intrapleural versus intravenous etoposide (VP 16) and teniposide (VM 26) in patients with malignant pleural effusion

The pharmacokinetics of etoposide (VP 16) and teniposide (VM 26) were studied after intrapleural administration to 3 patients with lung cancer and malignant pleural effusion. Comparison with the kinetic behavior of intravenously infused VP 16 and VM 26 in the same patients suggests that intrapleural drug delivery achieves higher and longer-lasting pleural concentrations, thus providing a theoretical basis for the palliative treatment of malignant pleural effusions. Although no systemic toxicity was observed after intrapleural administration of either drug, 1 of the 3 patients developed a transient asymptomatic hemorrhagic pleurisy during the first 2 days after the drug, alerting to the possible local toxicity of such treatment.     

Intrapleural cisplatin and mitomycin for malignant mesothelioma following pleurectomy: pharmacokinetic studies.

PURPOSE: Intrapleural cisplatin-based chemotherapy has been used in the treatment of patients with malignant pleural mesothelioma and malignant pleural effusions, but the pharmacokinetics of this form of chemotherapy have not been previously evaluated. We performed pharmacokinetic studies on 12 patients who received both intrapleural cisplatin and mitomycin immediately following pleurectomy/decortication for malignant pleural mesothelioma. PATIENTS AND METHODS: Simultaneous pleural fluid and plasma samples were collected at 15 and 30 minutes, and at 1, 2, 3, 4, and 24 hours after administration of the intrapleural chemotherapy (cisplatin 100 mg/m2 and mitomycin 8 mg/m2), and after cisplatin (total and free) and mitomycin levels were measured. The mean peak levels, the areas under the concentration-time curve (AUC) and the drug half-lives (t1/2s) in plasma and pleural fluid were compared using the paired t test. Differences were considered significant if P less than or equal to .05. RESULTS: Systemic absorption was rapid, with peak plasma levels being reached within 1 hour of administration of the intrapleural chemotherapy. Peak plasma levels measured after intrapleural chemotherapy approximated those reportedly attained during systemic administration of these drugs at similar doses. However, the mean peak cisplatin and mitomycin levels, and their mean AUCs, were significantly higher in the pleural fluid than in the plasma. There was a three- to fivefold advantage (on a logarithmic scale) for pleural to plasma AUCs for both cisplatin and mitomycin. The mean t1/2s for cisplatin and mitomycin were significantly longer in the plasma than in the pleural fluid. CONCLUSIONS: The pharmacokinetics of intrapleural cisplatin-based chemotherapy are analogous to those of intraperitoneal chemotherapy. Our findings show that intrapleural cisplatin-based chemotherapy has a distinct local pharmacologic advantage, but also produces significant and sustained drug plasma levels.     

微创中心静脉导管留置治疗恶性胸腔积液34例观察

目的 观察利用微创中心静脉导管留置胸腔在恶性胸腔积液的诊断和治疗中的作用.方法 2002年～2003年2月在外院内科治疗的大量或中等恶性胸腔积液的患者34例,利用微创技术应用美国ARROW公司中心静脉导管留置胸腔抽取胸液脱落细胞学检查,待结果阳性,给予胸腔注药,顺铂50mg～80mg,力尔凡100mg或胞必佳1 000u,地塞米松10mg,注药结束后,给予止吐药静点或静推,观察疗效及并发症.另选30例恶性胸腔积液患者常规穿刺、注药治疗为对照组,在疾病、病期、治疗药物方面与治疗组一致,没有分组差异,疗效分析采用χ2检验,平均确诊时间采用t检验.结果 在治疗效果中,治疗组CR 9例、PR 19例,有效率达82.35%,对照组CR 2例、PR 11例,有效率为40.33%,χ2＝10.539,P＜0.01.确诊时间治疗组1～8天,平均5.0天;对照组1～24天,平均14.5天,t＝8.7,P＜0.05.具有显著差异.无严重并发症.结论 利用微创技术采用中心静脉导管留置胸腔在诊断和治疗恶性胸腔积液方面具有优势,值得临床推广.