肺癌恶性胸腔积液经肋间动脉介入化疗的意义及多途径治疗方案探讨  

Studies of the significance of intercostal arterial infusion in multi-interventional therapy for malignant pleural effusion with pulmonary carcinoma

作　　者：张家裕[1] 王永武[2] 茅爱武[3] 周永新[2] 

机构地区：[1]上海中医药大学附属普陀医院,上海200062 [2]上海同济大学附属同济医院 [3]上海市同仁医院

出　　处：《外科研究与新技术》2012年第1期56-60,共5页Surgical Research and New Technique

摘　　要：目的探讨肺癌伴恶性胸腔积液(MPE)经肋间动脉灌注化疗的意义及多途径治疗方案。方法共20例肺癌伴MPE患者,置管引流后,对2例肺不能复张者行胸膜剥脱术和病理检查,其余18例肺复张后被随机分为三组,每组6例,分别将卡铂经支气管动脉、肋间动脉和肺动脉灌注化疗,连续多时点测定新产生的胸腔积液中铂离子的浓度,比较胸腔积液中铂(Pt)离子的浓度变化,丝裂霉素和表阿霉素均经其他两条途径灌注,然后统一进行高聚金葡素胸腔内灌注,并观察临床疗效。结果三种途径灌注后胸腔积液中铂离子浓度随时间变化趋势相似,肋间动脉灌注组Pt离子浓度明显高于支气管动脉灌注组和肺动脉灌注组(P<0.05)。本组患者胸腔积液治疗有效率为94.4%,肺部实体瘤有效率为50%,副反应轻微,治疗前后生活质量大幅度改善(P<0.05)。结论对于肺癌伴MPE患者的介入化疗应注重肋间动脉灌注化疗。Objective To study the mechanism and of interventional chemotherapy through the intercostal arteries and evaluate multiple treatment plans for malignant pleural effusion with pulmonary carcinoma.Methods 20 MPE cases totally.Pleurectomy are performed on 2 cases of them with trapped lung for pathological study.The rest 18 cases were divided into three groups,6 cases in each group:carboplatin was administrated through bronchial artery in groupⅠ,through intercostal artery in groupⅡ,and through pulmonary artery in groupⅢ.All patients were treated with small-bore catheter drainage system,interventional chemotherapy and HASL.The Pt concentration in pleural effusion of three groups were compared at different time after carboplatin administration and their clinical results,side effects and life quality improvement were observed.Results Pt concentration curves of the three groups were similar to each other,rose quickly after administration of carboplatin,reached a peak 1 hour or so later,and then began to decrease slowly,but still kept certain levels after 12 hours.Pt concentration of group Ⅱwas obviously higher than that of the other two groups (P<0.05).Pt concentration of groupⅠand group Ⅲ were low,and had no difference between the two groups (P>0.05).The side effects of 18 cases were insignificant.The rates of CR+PR for pleural effusion and pulmonary carcinoma were 94.4% and 50% respectively,and life quality improved significantly after the treatment(P<0.05).Pathological study found embolus of tumor cells in lymphatic vessels of parietal pleura.Conclusion MPE with lung cancer mainly caused by parietal pleura metastasis supplied by intercostal artery,thus we may lay particular emphasis on intercostal artery intervention chemotherapy for MPE with pulmonary carcinoma.The combined therapy of small-ball catheter drainage system,local administration of HASL in pleural cavity and multi interventional therapy is safe,effective and deserving of being widely used.

关 键 词：胸膜腔积液 肺癌 介入化疗 卡铂 

分 类 号：R734.2[医药卫生—肿瘤]