目的 :探讨胸腔镜胸膜剥除术加综合性治疗恶性胸水的临床疗效。方法 :应用电视胸腔镜技术施行 2 1例恶性胸水的胸膜剥除术 ,术中用顺铂 2 0mg加注射用水 2 0 0ml冲洗胸腔 ,术后再辅以局部 2～ 3周期和全身 4个周期化疗的综合性治疗 2 1例肺内、外肿瘤并恶性胸水病人。治疗完成后 ,参考WHO近期疗效评价标准和生存质量KPS评分标准进行评价。结果 :随访率 10 0 % ,胸水完全缓解率为 90 .5 % ,有效率 10 0 %。自觉症状均得到明显改善 ,治疗后KPS评分较治疗前均提高 2 0分以上 ,有显著性差异 ,P <0 .0 5。生存期超过 6个月以上 2 0例。结论 :胸腔镜胸膜剥除术辅以术后的局部和全身化疗的综合性治疗模式可有效地提高恶性胸水病人的生活质量和延长生存时间 Objective: To investigate the clinical effect of thoracoscopic pleural ablation plus comprehensive treatment of malignant pleural effusion. Methods: Thirty-two cases of malignant pleural effusion were treated with video-assisted thoracoscopic surgery. The patients were treated with 200 mg cisplatin plus 200 ml water for injection in the thoracic cavity. The operation was followed by 2 to 3 partial cycles and 4 whole-body cycles Comprehensive treatment of chemotherapy 21 cases of pulmonary and external tumor and malignant pleural effusion. After the treatment is completed, reference to the WHO recent evaluation of efficacy and quality of life KPS rating criteria for evaluation. Results: The follow-up rate was 100%. The pleural effusion remission rate was 90.5% and the effective rate was 100%. Subjective symptoms were significantly improved. After treatment, KPS scores increased by more than 20 points before treatment, with significant difference (P <0.05). Survival of more than 6 months 20 cases. Conclusion: The combined treatment of thoracoscopic pleural ablation and postoperative local and systemic chemotherapy can effectively improve the quality of life and extend the survival time of patients with malignant pleural effusion