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1、射頻透熱與化療綜合治療惡性體腔積液410013長沙中南大學(xué)湘雅三醫(yī)院腫瘤科曹培國,張雋,唐又群,姚志平,張震,符慧群,潘宇亮【摘要】目的評價熱化綜合治療惡性體腔積液的療效、毒副反應(yīng)及對生活質(zhì)量的影響。方法86例病人均是經(jīng)過手術(shù)、放射治療和(或)多程化療后復(fù)發(fā)及廣泛轉(zhuǎn)移的患者,其中胸水49例,心包積液3例,腹水50例;先行穿刺引流并以單藥或二聯(lián)化療藥物行腔內(nèi)注射,常用藥物為DDP(順鉑)50~100mg,MMC(絲裂霉素)8~10mg,5-Fu(氟脲嘧啶)1.0~1.5g,THP-ADM(吡喃阿霉素)40mg,腔內(nèi)化療1~6次,平均3次;患者一般情況改善后行全身化療,根據(jù)不同病種選擇不同
2、用藥方案;每次腔內(nèi)及靜脈化療后即行射頻透熱,2次/周,平均6次,腔內(nèi)溫度控制在42℃左右并維持40~60min。結(jié)果49例胸水CR26例,PR17例,有效率87%;3例心包積液均CR;50例腹水CR24例,PR14例,有效率76%;不同病種有效率不同,以乳腺、肺、卵巢及胃腸道腫瘤并積液者療效較好。治療后Karnofsky評分80~100組由0%上升到28%,60~70組由23%上升到43%,0~30組治療前后無明顯變化。與熱療相關(guān)的主要副反應(yīng)為局部皮膚疼痛(17%)和皮下脂肪硬結(jié)(11%)。結(jié)論熱化綜合治療惡性體腔積液有較好療效,并可明顯改善患者生活質(zhì)量,毒副反應(yīng)可耐受?!娟P(guān)鍵詞】惡性
3、胸腔積液;惡性心包積液;腹水;熱療;化療;生活質(zhì)量9TreatmentofmalignantpleuralorpericardialeffusionandascitesusinghyperthermiacombinedwithchemotherapyCAOPei-guo,ZHANGJun,TANGYou-qun,etal.DepartmentofOncology,TheThirdXiangyaHospital,CentralSouthUniversity,Changsha410013,China【Abstract】Objective:Toevaluatetheefficacyandto
4、leranceofhyperthermiacombinedwithchemotherapyintreatmentofmalignantpleuralorpericardialeffusionandascites.Methods:All86caseswererecurrentormetastaticcancerpatients.49caseshadmalignantpleuraleffusion,3caseshadmalignantpericardialeffusionand40caseshadascites.Afterdrainage,oneortwochemotherapeuticd
5、rugssuchasDDP50~100mg,MMC8~10mg,5-Fu1.0~1.5gorTHP-ADM40mgwereinjectedintothepleural,pericardialorperitonealcavity.Bythetimethepatient’ssymptomssuchasdysponeaorabdominaldistentionrelief,systemchemotherapybegan.Eachtimechemotherapywasfollowedbyhyperthermiawhichmaintainedthecavity’stemperatureat42℃
6、for40~60minutes.Hyperthermiawasperformedtwiceperweekfor3~4weeks(6timesatmeans).Then,theefficacy,qualityoflifeandtoxicitieswereevaluated.Results:Theresponseratewas87%in49caseswithmalignantpleuraleffusionand76%in50caseswithascitesand100%in3caseswithmalignantpericardialeffusion.Theresponseratewasbe
7、tterinbreast,lung,ovariananddigestivetractcancerpatientswithmalignantpleuraleffusionorascites.Aftercombinedtreatment,theKarnofskyscoresrisedfrom0%to28%at80~100groupandfrom23%to43%at60~70group,buttherewasnodifferenceat0~30gro