86例恶性体腔积液的热化综合治疗  

Treatment of Malignant Pleural or Pericardial Effusion and Ascites Using Hyperthermia Combined with Chemotherapy

作　　者：曹培国[1] 张隽[1] 唐又群[1] 姚志平[1] 张震[1] 潘宇亮[1] 

机构地区：[1]中南大学湘雅第三医院肿瘤科

出　　处：《临床肿瘤学杂志》2005年第2期148-151,共4页Chinese Clinical Oncology

摘　　要：目的:评价热化综合治疗恶性体腔积液的疗效、毒副反应及对生活质量的影响.方法:86例病人均是经过手术、放射治疗和(或)多程化疗后复发及广泛转移的患者,其中胸水49例,心包积液3例,腹水50例;先行穿刺引流并以单药或二联化疗药物行腔内注射,常用药物为顺铂(DDP)50～100 mg,丝裂霉素(MMC)8～10 mg,氟尿嘧啶(5-Fu)1.0～1.5 g,吡喃阿霉素(THP)40 mg,腔内化疗1～6次,平均3次;患者一般情况改善后行全身化疗,根据不同病种选择不同用药方案;每次腔内及静脉化疗后即行射频透热,2次/周,平均6次,腔内温度控制在42 ℃左右,并维持40～60 min.结果:49例胸水CR 26例,PR 17例,有效率87%;3例心包积液均CR;50例腹水CR 24例,PR 14例,有效率76%;不同病种有效率不同,以乳腺、肺、卵巢及胃肠道肿瘤合并积液者疗效较好.治疗后Karnofsky评分80～100分组的比例由0%上升到28%,60～70分组由23%上升到43%,0～30分组治疗前后无明显变化.与热疗相关的主要副反应为局部皮肤疼痛(17%)和皮下脂肪硬结(11%).结论:热化综合治疗恶性体腔积液有较好疗效,并能明显改善患者生活质量,毒副反应可以耐受.Objective：To evaluate the efficacy and tolerance of hyperthermia combined with chemotherapy in treatment of malignant pleural or pericardial effusion and as cites. Methods ： All 86 cases were recurrent or metastatic cancer patients. 49 cases had malignant pleural effusion ,3 cases had malignant pericardial effusion and 40 cases had ascites. After drainage,one or two chemotherapeutic drugs such as DDP 50 - 100 mg,MMC 8 - 10 mg,5-Fu 1.0 - 1.5 g or THP-ADM 40 mg were injected into the pleural,pericardial or peritoneal cavity. By the time the patients＇ symptoms such as dysponea or abdominal distention relief,system chemotherapy began. Each time chemotherapy was followed by hyperthermia which maintained the cavity＇s temperature at 42 ℃ for 40 - 60 minutes. Hyperthermia was performed twice per week for 3 - 4 weeks（6 times at means）. Then, the efficacy, quality of life and toxieities were evaluated. Resuits：The response rate was 87% in 49 cases with malignant pleural effusion and 76% in 50 cases with ascites and 100% in 3 cases with malignant pericardial effusion. The response rate was better in breast,lung,ovarian and digestive tract cancer patients with malignant pleural effusion or ascites. After combined treatment,the Karnofsky scores rised from 0% to 28% at 80 - 100 group and from 23% to 43% at 60 -70 group,but there was no difference at 0 -30 group. The main side effects of hyperthermia were local skin pain（ 17% ） and fat necrosis（ 11% ）. Conclusion： Hyperthermia combined with chemotherapy is effective in the treatment of malignant pleural or pericardial effusion and ascites,and this treatment can improve the quality of life. The side effects are tolerable.

关 键 词：恶性胸腔积液 恶性心包积液 热疗 化疗 

分 类 号：R730.53[医药卫生—肿瘤]