胸腔镜滑石粉胸膜固定术延长恶性胸膜间皮瘤患者生存时间的临床分析  

Thoracoscopic talc pleurodesis prolong survival for malignant pleural mesothelioma

作　　者：韩敬泉[1] 李吉尧[1] 曹守强[1] 董庆[1] 崔键[1] 张凯[1] 赵桂彬[1] 阎宇博[1] 

机构地区：[1]哈尔滨医科大学附属第四医院,黑龙江哈尔滨150001

出　　处：《中国内镜杂志》2013年第8期823-827,共5页China Journal of Endoscopy

摘　　要：目的探讨胸膜间皮瘤患者行胸腔镜胸膜固定术后生存期延长的可能原因。方法 1998年12月~2008年7月,笔者对于伴有胸腔积液的间皮瘤患者使用胸腔镜滑石粉胸膜固定作为主要的治疗手段。对连续的,有症状的,并接受胸腔镜胸膜活检的528例胸腔积液患者的临床资料进行分析,其中52例最终被诊断为恶性胸膜间皮瘤。对这些患者进行随访直至死亡。结果胸腔镜下滑石粉胸膜固定术后患者的平均生存时间（18.5±4.8）个月（中位生存时间18.0个月,范围9.8~36.9个月）。log-rank和Cox风险模型分析结果显示：胸腔镜胸膜固定术后生存时间的长度与性别、细胞类型、胸膜结节的数量、胸水的颜色、胸痛表现、石棉暴露史、吸烟史、疾病分期及放化疗无关。患者的呼吸困难症状在胸膜固定后均得到缓解。没有1例发生围手术期死亡,1例手术后并发肺炎。平均住院时间（5.9±2.7）d。结论滑石粉胸膜固定可能通过消除积液中肿瘤细胞生长的液态微环境而间接发挥治疗作用。【Objective】The mesothelioma patients had prolonged survival after talc poudrage,the patient data was analyzed to determine the possible causes.【Methods】From December 1998 to July 2008,we performed thoracoscopic talc poudrage（TTP） as a primary therapy in mesothelioma patients presenting with pleural effusion.We reviewed all 52 patients with a final diagnosis of malignant pleural mesothelioma from our prospective database of 528 consecutive patients who received thoracoscopy for recurrent symptomatic pleural effusion.Patients were followed up until their death.【Results】Mean survival after TTP was（18.5±4.6） months（median 18.0,range 9.8-36.9）.Results of log-rank tests and the Cox proportional hazards model showed that the length of survival time following TTP was not associated with gender,primary symptoms,cell type,number of nodules seen,color of the pleural fluid,presence of initial chest pain,history of asbestos exposure,history of tobacco use,disease stage or duration of either chemotherapy or radiation therapy.Pleurodesis palliated dyspnoea in all patients.No perioperation deaths and one postoperative complication（pneumonia） occurred.Mean hospital stay was（5.9±2.7） days.【Conclusion】Talc pleurodesis may be through the elimination of the tumor-cell microenvironment in malignant effusions and indirectly plays a therapeutic role.

关 键 词：肿瘤微环境 恶性胸膜间皮瘤 电视胸腔镜 胸膜固定 

分 类 号：R730.5[医药卫生—肿瘤]