陈林++孙立柱

DOI：10.16662/j.cnki.1674-0742.2017.11.139

[摘要] 目的 探究化疗联合顺铂胸腔灌注治疗肺癌伴恶性胸腔积液的临床疗效。方法 随机选取该院2014年1月—2016年12月收治的肺癌伴恶性胸腔积液患者60例，随机平分为两组。观察组患者采用化疗联合顺铂胸腔灌注治疗，对照组患者采用吉西他滨联合顺铂全身化疗。比对两组在治疗疗效、药物不良反应、生活质量的差异。 结果 观察组临床疗效总有效率80.0%明显高于对照组总有效率50.0%（P<0.05）；两组不良反应以Ⅰ级、Ⅱ级为主，观察组患者在骨髓抑制、胃肠道反应、肝功能损伤等不良反应发生率与对照组差异无统计学意义（P>0.05）；观察组患者生活质量改善率70.0%优于对照组50.0%，对比差异有统计学意义（P<0.05），但顺铂胸腔灌注使胸腔粘连，致包裹性胸腔积液，引起胸闷、气喘、呼吸困难。结论 顺铂胸腔灌注治疗疗效虽优于全身化疗，但顺铂胸腔灌注可使部分患者引起严重的包裹性胸腔积液，导致部分患者出现胸闷气喘、呼吸困难的不良反应，较大的影响患者生活質量。因此，在治疗肺癌伴恶性胸腔积液治疗中可首选全身化疗。对于一般状况差，预计生存期短的患者，可采取胸腔灌注。

[关键词] 化疗；顺铂胸腔灌注；肺癌；恶性胸腔积液

[中图分类号] R734.2 [文献标识码] A [文章编号] 1674-0742（2017）04（b）-0139-03

Analysis of Clinical Observation of Chemotherapy and Cis-platinum in the Thoracic Perfusion Treatment of Lung Cancer and Malignant Pleural Effusion

CHEN Lin， SUN Li-zhu

Department of Oncology， Shuyang Peoples Hospital， Suqian， Jiangsu Province， 223600 China

[Abstract] Objective To study the clinical curative effect of chemotherapy and cis-platinum in the thoracic perfusion treatment of lung cancer and malignant pleural effusion. Methods 60 cases of patients with lung cancer and malignant pleural effusion admitted and treated in our hospital from January 2014 to December 2016 were selected and randomly divided into two groups， the observation group adopted the chemotherapy and cis-platinum thoracic perfusion treatment， while the control group adopted the gemcitabine and cis-platinum， and the treatment curative effect， drug toxic and side effect and quality of life were compared between the two groups. Results The total clinical effective rate in the observation group was obviously higher than that in the control group（80.0% vs 50.0%）（P<0.05）， and the differences in the incidence rate of adverse reactions such as myelosuppression， gastrointestinal reaction and liver function injury between the two groups were not obvious，（P>0.05）， and the toxic and side effect were mainly Ⅰand Ⅱ（P>0.05）. The improvement rate of quality of life in the observation group was better than that in the control group（70.0% vs 50.0%）， and the difference was obvious by comparison（P<0.05）， but the cis-platinum thoracic perfusion caused the chest distress， wheezing and dyspnea. Conclusion The curative effect of cis-platinum thoracic perfusion is better than that of systemic chemotherapy， but it can lead to the severe encapsulated pleural effusion thus making some patients chest distress， wheezing and dyspnea， greatly affecting the quality of life of patients， therefore， the systemic chemotherapy is the first choice in treatment of lung cancer and malignant pleural effusion， but for patients with bad general condition and short survival period， we can adopt the thoracic perfusion.

[Key words] Chemotherapy； Cis-platinum thoracic perfusion； Lung cancer； Malignant pleural effusion

恶性胸腔积液是中晚期恶性肿瘤常见并发症，约40%左右肺癌患者出现恶性胸腔积液的症状[1]。肺癌并发胸腔积液临床表现为进行性呼吸困难、偶有干咳、胸痛等症状。症状严重程度与胸腔积液量、肺功能相关，如胸腔积液未及时治疗，积液量不断增加压迫内脏器官，加重患者呼吸压力，带给患者极大的痛苦[2-3]。……