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CR26例,PR17例,有效率87%;3例心包积液均CR;50例腹水CR24例,PR14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Treatmentofmalignantpleuralorpericardialeffusionandascitesusinghyperthermiacombinedwithchemotherapy1CAOPei-guo,ZHANGJun,TANGYou-qun,etal.DepartmentofOncology,TheThirdXiangyaHospital,CentralSouthUniversity,Changsha410013,China【Abstract】Objective:Toevaluatetheefficacyandtoleranceofhyperthermiacombinedwithchemotherapyintreatmentofmalignantpleuralorpericardialeffusionandascites.Methods:All86caseswererecurrentormetastaticcancerpatients.49caseshadmalignantpleuraleffusion,3caseshadmalignantpericardialeffusionand40caseshadascites.Afterdrainage,oneortwochemotherapeuticdrugssuchasDDP50~100mg,MMC8~10mg,5-Fu1.0~1.5gorTHP-ADM40mgwereinjectedintothepleural,pericardialorperitonealcavity.Bythetimethepatient’ssymptomssuchasdysponeaorabdominaldistentionrelief,systemchemotherapybegan.Eachtimechemotherapywasfollowedbyhyperthermiawhichmaintainedthecavity’stemperatureat42℃for40~60minutes.Hyperthermiawasperformedtwiceperweekfor3~4weeks(6timesatmeans).Then,theefficacy,qualityoflifeandtoxicitieswereevaluated.Results:Theresponseratewas87%in49caseswithmalignantpleuraleffusionand76%in50caseswithascitesand100%in3caseswithmalignantpericardialeffusion.Theresponseratewasbetterinbreast,lung,ovariananddigestivetractcancerpatientswithmalignantpleuraleffusionorascites.Aftercombinedtreatment,theKarnofskyscoresrisedfrom0%to28%at80~100groupandfrom23%to43%at60~70group,buttherewasnodifferenceat0~30group.Themainsideeffectsofhyperthermiawerelocalskinpain(17%)andfatnecrosis(11%).Conclusion:Hyperthermiacombinedwithchemotherapyiseffectiveinthetreatmentofmalignantpleuralorpericardialeffusionandascites,andthistreatmentcanimprovethequalityoflife.Thesideeffectsaretolerable.【Keywords】Malignantpleuraleffusion;MalignantpericardialeffusionAscites;Hyperthermia;Chemotherapy;Qualityoflife恶性胸、腹腔和心包积液为晚期恶性肿瘤的严重并发症,常表现为呼吸困难、胸背胀痛、腹胀等不适,严重损害了患者的生活和生存质量,最后因呼吸、2循环障碍及严重的水电解质紊乱而死亡。既往治疗恶性体腔积液的常用方法为穿剌引流、腔内局部化疗或注入生物反应调节剂等,但这些方法治疗效果常不理想且存在严重的毒副反应。2000年12月至2003年6月,我们采用局部射频透热与低剂量化疗结合的方法治疗恶性体腔积液患者86例,取得了较好的近期疗效,并明显改善了患...