CAJ | 학술논문

目的评价B超引导下持续循环胸腔热灌注(continuous circulatory intrapleural perfusion hyperthermia,CCIPH)治疗各种恶性肿瘤引起的恶性胸腔积液的可行性、临床疗效及毒副反应.方法选取13例恶性肿瘤合并胸膜转移、胸腔积液患者,经胸片或胸部CT明确存在中-大量胸腔积液,且胸腔积液经细胞学检查明确可查见癌细胞.本组13例患者均在B超引导定位下行胸腔穿刺置管术,分别留置灌注管和排液管,所有操作均在局麻下进行.灌注液为蒸馏水,总量约2500～3500 ml,灌注速度300～400 ml/min,灌注时间60 min,治疗温度(48±0.2)℃,每例灌注2～3次,两次治疗之间时间间隔为48 h.结果所有13例患者均顺利进行B超引导下CCIPH,人体温度为(48.00±0.20)℃,出体温度为(44.98±0.22)℃.患者均耐受良好.9例患者胸腔积液完全缓解,4例部分缓解.CCIPH后1个月左右复查胸部CT,发现肺部原发灶缩小者6例,基本不变者7例.患者KPS评分上升均在10分以上,肿瘤标志物不同程度下降,无严重副作用.结论 B超引导下CCIPH治疗恶性胸腔积液安全性高,患者耐受良好,方法简便易行,近期疗效满意.
목적 평개B초인도하지속순배흉강열관주(continuous circulatory intrapleural perfusion hyperthermia,CCIPH)치료각충악성종류인기적악성흉강적액적가행성、림상료효급독부반응.방법 선취13례악성종류합병흉막전이、흉강적액환자,경흉편혹흉부CT명학존재중-대량흉강적액,차흉강적액경세포학검사명학가사견암세포.본조13례환자균재B초인도정위하행흉강천자치관술,분별류치관주관화배액관,소유조작균재국마하진행.관주액위증류수,총량약2500～3500 ml,관주속도300～400 ml/min,관주시간60 min,치료온도(48±0.2)℃,매례관주2～3차,량차치료지간시간간격위48 h.결과 소유13례환자균순리진행B초인도하CCIPH,인체온도위(48.00±0.20)℃,출체온도위(44.98±0.22)℃.환자균내수량호.9례환자흉강적액완전완해,4례부분완해.CCIPH후1개월좌우복사흉부CT,발현폐부원발조축소자6례,기본불변자7례.환자KPS평분상승균재10분이상,종류표지물불동정도하강,무엄중부작용.결론 B초인도하CCIPH치료악성흉강적액안전성고,환자내수량호,방법간편역행,근기료효만의.
Objective To assess the feasibility,clinical efficacy and toxicities of continuous circulatory intrapleural perfusion hyperthermia(CCIPH) under B ultrasound guidance in the treatment of malignant pleural effusion(MPE) caused by various kinds of carcinoma.Methods CCIPH B ultrasound guidance was carried out in 13 patients with carcinoma complicated by malignant pleural effusion.Pleural effusion was proved by chest roentgenogram studies or computed tomography in all patients.Pleurocentesis was performed before CCIPH.Malignant cell was found in the pleural effusion of all the patients.Tow tubes for irrigation inlet and outlet,which were inserted into the pleural cavity under the positioning of B ultrasound,were connected to BR-TRG-I-type hyperthermic perfusion intraperitonela treatment system (Guangzhou,China).All operations were performed under local anesthesia.The thoracic cavity was irrigated for 60 min with (48.00 ± 0.20) ℃ distilled water (about2,500-3,500 ml) 300-400 ml/min.CCIPH was carried out for 2 or 3 times,with a 48 h interval.Results All patients successfully completed this treatment with acceptable toxicities and stable inlet temperature of (48.00 ± 0.20) ℃ and outlet temperature of (44.98 ± 0.22) ℃ and without serious side effects.The control rate of pleural effusion was 100％.CT performed in 6 cases about 1 month after CCIPH showed that the primary focus in lung dwindled,and remained unchanged in 7 cases.The KPS was improved in all the cases.Tumor markers were decreased.Conclusion This less invasive modality seems to offer a safe,feasible and excellent local control for MPE.