背景与目的：恶性腹腔积液是晚期恶性肿瘤患者常见的并发症，大量腹腔积液不仅影响患者生活质量，更会进一步继发呼吸、循环、消化等系统功能障碍。如何处理晚期癌症患者恶性腹腔积液，成为姑息治疗工作者面临的常见问题。该研究回顾性分析71例晚期恶性肿瘤合并恶性腹腔积液患者的腹水性质，评价引流及灌注治疗效果，分析影响恶性腹腔积液临床获益率的影响因素，以期更好地指导临床实践。方法：回顾性分析71例腹腔积液患者临床资料。疗效评估参考世界卫生组织(WHO)标准：完全缓解(CR)：腹水完全消失，症状缓解并持续1个月以上；部分缓解(PR)：腹水减少50%以上，症状缓解并持续1个月以上；稳定(SD)：腹水减少不足50%，症状部分缓解；进展(PD)：腹水无减少或增加，症状加重。CR+PR为有效率，CR+PR+SD为临床获益率。计量资料间的比较采用单因素方差分析，多组之间率的比较采用卡方检验。对影响疗效的因素进行单因素分析。结果：接受腹腔积液引流的患者，平均引流量为8537 mL，中位引流量为5750 mL。平均持续引流时间为7 d。其中16例患者接受2次以上重复穿刺。71例纳入研究的患者获得CR 7例，PR 19例，SD 34例，PD 11例，有效率为36.62%(CR+PR)，临床获益率为84.51%(CR+PR+SD)。分析影响临床获益率的相关因素，年龄、性别、原发病灶及患者KPS评分均同疗效无明显相关性。腹水相关因素中，患者腹水中乳酸脱氢酶(lactate dehydrogenase，LDH)含量为影响腹水处理疗效的因素(P=0.04)。经腹腔灌注顺铂(DDP)60 mg+香菇多糖10mg的患者较其他患者有较好的获益率(P=0.013)，其余因素包括腹水性状、引流量等均同疗效无明显相关性。结论：腹腔积液引流结合香菇多糖联合顺铂腹腔灌注，在不明显增加不良反应的同时，较为有效地控制了晚期恶性肿瘤患者的恶性腹腔积液，值得临床进一步推广实践。%Background and purpose:Malignant ascites is deifned as abnormal accumulation of lfuid within the peritoneal cavity caused by the intraperitoneal spread of original cancer. Ascites-related symptoms seriously affect patients’ quality of life. Therapies for these patients are generally aimed to relieve ascites-related symptoms, alleviate patients’ sufferings and improve their quality of life. The aim of this research was to analyze the effectiveness of abdominal paracentesis and peritoneal drainage in management of malignant ascites of terminally ill cancer patients. Methods:The data from 71 patients who received abdominal paracentesis in Palliative Care Department were collected from Mar. 2010 to Oct. 2012. The treatment responses of complete remission (CR), partial response (PR), stable disease (SD) and progressive disease (PD) by World Health Organization (WHO) criteria were used to assess the effectiveness of the drainage and infusion.Results:The average volume of drainage lfuid was 5 750 mL. The mean duration for drainage was 7 days. Sixteen patients received repeated paracentesis. Twenty-six patients (36.62%) were considered effective (CR+PR), and 60 patients (84.51%) got a clinical beneift (CR+PR+SD), while 11 patients (15.49%) were PD. The median relief time for ascites was 18 days. The biological characteristics of the ascites and primary tumor site had no relationship with the effect of the ascite control. Lactate dehydrogenase (LDH) level in the ascites (P=0.04)and intraperitoneal injection (DDP 60 mg and lentinan 10 mg) (P=0.013) were related with the beneift.Conclusion:Combined use of abdominal drainage and infusion is still an effective method for relieving symptoms in terminally ill cancer patients with malignant ascites, although the median relief time is short. How to prolong the relief time with few adverse effects for these patients is deserved to be further studied.
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