局部胸腔灌注化疗联合全身化疗对肺腺癌合并恶性胸腔积液的疗效

摘要

目的 探讨局部胸腔灌注化疗联合全身化疗对肺腺癌合并恶性胸腔积液的疗效.方法 回顾性分析85例肺腺癌合并恶性胸腔积液患者的临床资料,根据治疗方法不同将患者分为局部组(n=38)和联合组(n=47).局部组将顺铂+白细胞介素-2经胸腔置管引流后注入胸腔,联合组在局部组的基础上辅以培美曲塞全身化疗.比较两组患者恶性胸腔积液的治疗效果、治疗前后KPS评分变化以及治疗后的不良反应发生率.结果 联合组患者恶性胸腔积液的治疗有效率为93.62%,明显高于局部组的44.74%(P﹤0.01);联合组患者KPS评分改善有效率为80.85%,高于局部组的44.74%(P﹤0.05).两组患者的各种不良反应发生率比较,差异均无统计学意义(P﹥0.05).但联合组中个别患者出现白细胞减少、胸痛及胃肠道反应等3级不良反应,需及时对症治疗.结论 在顺铂+白细胞介素-2胸腔灌注化疗的基础上辅以培美曲塞全身化疗,可有效治疗肺腺癌合并恶性胸腔积液,值得临床推广.%Objective To study the effect of thoracic cavity perfusion combined with systemic chemotherapy in the treatment of lung adenocarcinoma complicated with malignant pleural effusion. Method Clinical data of 85 patients with lung adenocarcinoma complicated with malignant pleural effusion were retrospectively analyzed, and the patients were divided into local group (n=38) and combined group (n=47) according to their treatment. The patients in both groups were injected with cisplatin and interleukin Ⅱ after chest drainage using catheters, and the patients in combined group were additionally given systemic chemotherapy with pemetrexed. The therapeutic effect on malignant pleural effu-sion, change in KPS scores between before and after treatment and the incidence of adverse reactions after treatment were compared between two groups. Result The response rate in the treatment of malignant pleural effusion in combined group was 93.62%, significantly higher than that in local group (44.74%, P<0.01);the improvement rate of KPS score in combined group was 80.85%, higher than that of local group (44.74%, P<0.05). There was no significant difference found in any incidence of adverse reactions between the two groups (P>0.05). But several patients in the combined group had grade 3 adverse reactions, such as leukopenia, chest pain and gastrointestinal reaction, which needed timely symptom-atic treatment. Conclusion The combined therapy of cisplatin+interleukinⅡthoracic cavity perfusion and systemic che-motherapy with pemetrexed is effective in the treatment of malignant pleural effusion and deserves further clinical appli-cation.