胸腔镜局部肿瘤切除术联合胸膜热烧灼术治疗肺癌恶性胸腔积液的疗效分析

目的:探讨胸腔镜辅助局部肿瘤切除术联合胸膜热烧灼术对肺癌恶性胸腔积液(malignant pleural effusion,MPE)的疗效。方法:2009年1月—2012年12月对49例肺癌MPE患者(手术组)行胸腔镜辅助下局部肿瘤切除术联合胸膜热烧灼术,以同期38例行胸腔化疗的肺癌MPE患者作为对照(对照组),观察治疗前后患者血清肺癌标志物浓度的变化情况,比较两组患者胸水的控制情况以及患者生存期。结果:术前手术组与对照组中肿瘤标志物癌胚抗原(carcinoembryonic antigen,CEA)和癌抗原-125(carbohydrate antigen-125,CA-125)浓度差异无统计学意义,手术组术后肿瘤标志物CEA和CA-125与对照组治疗后相比明显降低(P0.05)。手术组MPE控制有效率100%,对照组为55%,两组差异有统计学意义(P0.05);手术组与对照组中位数生存期分别为21.7个月、12.7个月,两组比较差异有统计学意义(P0.01),手术组1年生存率明显高于对照组(79.1%比51.4%,P0.01)。结论:胸腔镜辅助下局部肿瘤切除术联合胸膜热烧灼术对肺癌MPE患者有明显治疗效果。

Efficacy of Pleura Thermal Ablation Combined with Local Tumor Excision under Thoracoscopy in the Treatment of Lung Cancer with Malignant Pleural Effusion

Objective：To explore the clinieal efficacy of pleura thermal ablation combined with local tumor excision under tho- racoscopy in the treatment of lung cancer with malignant pleural effusion （MPE）. Methods：From January 2009 to December 2012, 49 lung cancer patients with MPE （operation group） had undergone treatment of pleura thermal ablation combined with local tumor excision under thoracoscopy. Another 38 patients who had undergone intrapleural chemotherapy in the same period were enrolled as the control group. Tumor marker levels were detected before and after operation. The control rate of pleural effusion and survival rate of the patients were compared between the two groups. Results： There were no significant differences in carcinoembryonic antigen （CEA） and carbohydrate antigen-125 （CA-125） concentrations between the two groups before operation, but the postoperative levels of CEA and CA-125 were significantly decreased in the operation group than those in the control group （P〈0.05）. The control rate of MPE was 100% in the operation group and 55% in the control group, and there was significant difference （P〈0. 05）. The 1-year survival rate of the operation group was significantly higher than that of the control group （79.1% vs. 51.4%, P〈0.01 ）. Conclusions： Pleura thermal ablation combined with local tumor excision under thoracoscopy is effective for lung cancer patients with MPE.