肺癌恶性胸腔积液胸腔镜下胸腔内循环灌注化疗临床分析

[目的]探讨胸腔镜辅助下胸腔内循环灌注化疗（TICPC）治疗肺癌恶性胸腔积液（MPG）的方法和疗效.[方法]将2004年5月至2008年3月期间80例肺癌MPG患者随机分为治疗组（A组,40例）和对照组（B组,40例）.A组在全身麻醉胸腔镜下行胸膜活检术,并胸腔内恒温43℃生理盐水3000 mL加顺铂300 mg灌注1 h;B组予胸腔引流,胸腔内灌注顺铂80～100 mg.比较两组治疗前后胸水量的变化,胸水中癌胚抗原（CEA）、乳酸脱氨酶（LDH ）、腺苷脱氨酶（ADA）浓度的变化和不良反应.[结果]A、B组有效率分别为87.5%和57.5%,差异有统计学意义（P〈0.05）.A、B两组治疗后胸水中LDH较治疗前明显上升（P〈0.05）,CEA均较治疗前明显下降（P〈0.05）,且A组较B组更为显著（P〈0.05）.两组治疗前后各种不良反应比较差异无统计学意义（P〉0.05）.[结论]TICPC 治疗肺癌 MPG创伤小、视野大,能直视下分离粘连,并准确对胸膜病变活检,具有较高的临床应用价值.

Clinical Analysis of Thoracoscopic Intrapleural Circular Perfusion Chemotherapy for the Treatment of Malignant Pleural Effusion Caused by Lung Cancer

[Objective] To explore the method and efficacy of thoracoscopic intrapleural circular perfusion ehemotherapy（TICPC） for the treatment of malignant pleural effusion （MPE） caused by lung cancer. [Methods]Totally 80 patients with MPE caused by lung cancer from May 2004 to March 2008 were randomly divided into treatment group（group A, n=40） and control group（group B, n=40）. Treatment group under-went pleural biopsy under general anesthesia and received intrapleural perfusion with 3000mL normal saline un-der 43℃ constant temperature and 300mg eisplatin. Group B underwent chest drainage and intrapleural perfu-siGn with 80-100mg cisplatin. The change of pleural fluid volume, carcinoembryonic antigen（CEA）, lactic dehydrogenase（LDH） and adenosine deaminase（ADA） in pleural fluid and side effects were compared before and after the treatment. [Results] The effective rate in group A and B was 87.5% and 57.5% respectively, and there was significant difference（ P〈0.05）. Compared with before treatment, CEA in pleural fluid in two groups obviously decreased（ P〈0.05）, and CEA in group A decreased more significantly than group B（ P〈0.05）. There was no significant difference in side effects in two groups between before and after treatment（ P〉0.05）. [Conclusion] TICPC for the treatment of MPE caused by lung cancer has small wound and wide visu-al field, and can separate the adhesion under direct vision, and undergo pleural biopsy, so it has high clinical value,