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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 investigate the effect of local thoracic infusion chemotherapy combined with systemic chemotherapy on lung adenocarcinoma with malignant pleural effusion. Methods The clinical data of 85 patients with adenocarcinoma with malignant pleural effusion were retrospectively analyzed. Patients were divided into local group (n = 38) and combined group (n = 47) according to different treatment methods. In the local group, cisplatin plus interleukin-2 was infused into the thoracic cavity through the thoracic duct and the combination group was treated with pemetrexed systemic chemotherapy on the basis of the local group. The treatment effect of malignant pleural effusion, the changes of KPS score before and after treatment, and the incidence of adverse reactions after treatment were compared between the two groups. Results The effective rate of treatment for malignant pleural effusion in the combined group was 93.62%, which was significantly higher than that in the local group (44.74%, P <0.01). The effective rate of KPS in the combined group was 80.85%, which was higher than that in the local group (44.74% P <0.05). There was no significant difference between the two groups in the incidence of various adverse reactions (P> 0.05). However, some patients in the combined group leukopenia, chest pain and gastrointestinal reactions, grade 3 adverse reactions, timely and symptomatic treatment. Conclusions The combination of cisplatin and interleukin-2 in thoracic cavity perfusion chemotherapy combined with pemetrexed systemic chemotherapy can effectively treat pulmonary adenocarcinoma with malignant pleural effusion, which is worthy of clinical promotion.