体腔热灌注化疗治疗恶性胸（腹）水的临床观察

摘要] 目的 观察体腔热灌注化疗治疗恶性胸（腹）水的疗效及不良反应。方法 治疗组为我科自2010年2月—8月收治的恶性胸（腹）水病人58例,对照组为我科自2009年6月—2010年2月收治的恶性胸（腹）水病人58例。所有患者在超声定位下行胸（或腹）腔置管，并适当引流胸(腹)水。治疗组将化疗药物的2/3用量及盐酸利多卡因0.1g、地塞米松5mg配制于2 000～3 000ml左右的无菌生理盐水中，利用体腔热灌注治疗仪将灌注药液温度控制在43℃～45℃，经留置引流管进行循环灌注，持续60分钟，最后将剩余的1/3量化疗药+生理盐水100ml注入胸（腹）腔内。对照组将所选化疗药物配制于45 ℃ 的无菌生理盐水（胸腔为50 mL,腹腔为1 000～2 000 mL）中,沿体腔留置引流管快速注入胸（腹）腔内。两组均在3周后重复治疗，2周期后评定疗效及不良反应。结果 治疗组总有效率为89.66%，对照组总有效率为67.24%，治疗组有效率明显高于对照组，有统计学意义（P<0.01）。两组不良反应无明显差异。结论 体腔热灌注化疗能够有效地控制恶性胸腹水的生长，且不良反应轻微，值得临床推广应用。

Clinical Observation of Coelom Hyperthermic Perfusion Chemotherapy in the Treatment of Malignant Pleural Effusion and Ascites

Abstract Objective:To observe the efficacy and adverse reaction of coelom hyperthermic perfusion chemotherapy in the treatment of malignant pleural effusion and ascites. Methods: 58 cases in the treatment group were from oncology inpatient of our hospital from February 2010 to August 2010, while 58 cases in the control group were from June 2009 to February 2010. All patients were placed Central Venous Catheter by ultrasound –guided, and the effusion was drained properly. Treatment group : two-thirds of the chemotherapeutic drugs with Lidocaine Hydrochloride 0.1g and Dexamethasone 5mg were put into 2000~3000ml normal saline，and then the medicinal liquid was perfused into body cavity by indwelling drainage tube circularly，maintainning at 43℃~45℃with coelom hyperthermic perfusion therapy machine and keeping 60 minutes,finally the remaining one-third of the chemotherapeutic drugs with normal saline 100ml was perfused into body cavity. Control group : the chemotherapeutic drugs were put into 50ml (thoracic cavity) or 1000-2000ml (abdominal) normal saline heated to 45℃ in advance，and then the medicinal liquid was perfused into body cavity by indwelling drainage tube quickly. The therapeutic schedule was applied once every three weeks in each group. The efficacy and adverse reaction were evaluated after two cycles. Results : The total effective rate in the treatment group was 89.66%, while that in the control group was 67.24%（P<0.01）. The adverse reactions were similar with no significant differences in the two groups.Conclusion：Coelom hyperthermic perfusion chemotherapy can effectively control the growth of malignant pleural effusion and ascites with mild adverse reaction. It’s worthy of applying to the clinical.