胸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

目的：探讨胸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的临床应用和疗效。方法：对46例合并多房性包裹性恶性胸腔积液的晚期癌症患者,先经皮穿刺中心静脉导管胸腔置管,后经导管注入尿激酶（20～30）万U（5000U/kg）融化包裹及分隔纤维组织,使胸水引流顺畅,尽可能放尽胸水后行胸腔内化疗。结果：46例患者胸腔注入尿激酶后均能使胸水通畅,干净,及时胸腔内化疗,继而全身化疗;治疗后CR（完全缓解）31例,PR（部分缓解）10例,NC（无效）5例;胸水控制总有效率89.13%。CR病人住院期控制胸水平均时间为37d;平均完全缓解期为11.7个月。所有患者对尿激酶胸腔注射有良好耐受性。结论：胸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方法简便,较常规胸穿减少了穿刺次数,减少了患者痛苦及治疗经费;此法胸水控制完全缓解率高,控制胸水时间短;与常规胸穿相比患者胸膜肥厚粘连程度轻,肺功能恢复良好。值得临床推广应用。

Treatment of Multilocular Encapsulated Malignant Pleural Effusion Intrapleural Injection of Urokinase Combined with Chemotherapy

Objective：To observe clinical application and effect of intrapleural injection of urokinase combined with chemotherapy for multilocular encapsulated malignant pleural effusion. Methods：46 case of advanced cancer patients complicated with muhilocular encapsulated malignant pleural effusion underwent firstly percutaneous puncture central venous catheter and left the canal within thoracic cavity, then transcatheter urokinase 200 000U -300 000U （5 000U/kg） melt inclusions and file separation of fibrous tissue, so that the smooth drainage of pleural effusion as far as possible to do. Finally intrathoracic chemotherapy was continued. Results ：After injection of urokinase, the drain showed hydrothorax smooth, clean and to contribute to perform intrathoracic chemotherapy and whole body chemotherapy. Results found the CR 31 cases, PR 10 cases, and NC 5 cases. Total effective rate of the control of pleural fluid was 89.13%. The average time of controlling pleural fluid of CR patients was 37d; the average complete remission was 11.7months. All patients had good toleration to urokinase injection. Conclusions：As compare with the conventional method, intrapleural injection of urokinase combined with chemotherapy is convenient; the patients will have less pain and treatment costs. And sueeessful rate of treatment and recovery are higher for Muhilocular Encapsulated Malignant Pleural Effusion.