射频透热与化疗综合治疗恶性体腔积液.docVIP

射频透热与化疗综合治疗恶性体腔积液 410013 长沙 中南大学湘雅三医院肿瘤科 曹培国，张 隽，唐又群，姚志平，张 震，符慧群，潘宇亮 【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DDP（顺铂）50～100mg，MMC （丝裂霉素）8～10mg，5-Fu （氟脲嘧啶）1.0～1.5g，THP-ADM（吡喃阿霉素）40mg，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40～60min。 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、卵巢及胃肠道肿瘤并积液者疗效较好。治疗后Karnofsky评分80～100组由0％上升到28％，60～70组由23％上升到43％，0～30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，并可明显改善患者生活质量，毒副反应可耐受。 【关键词】 恶性胸腔积液； 恶性心包积液； 腹水； 热疗； 化疗； 生活质量 Treatment of malignant pleural or pericardial effusion and ascites using hyperthermia combined with chemotherapy CAO Pei-guo, ZHANG Jun, TANG You-qun, et al. Department of Oncology, The Third Xiangya Hospital, Central South University, Changsha 410013, China 【Abstract】 Objective：To evaluate the efficacy and tolerance of hyperthermia combined with chemotherapy in treatment of malignant pleural or pericardial effusion and ascites. 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 50～100mg, 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 patient’s 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 toxicities were evaluated. Results：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