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原发性肺癌伴胸膜转移 ,恶性胸水、TNM分期上属 b 期肺癌 ,临床症状大部分为气促、胸痛等 ,一般以内科治疗为主 ,主要采取胸膜腔内注射消炎药、化疗药、免疫制剂等 ,引起胸膜炎症反应 ,产生化学性粘连。但疗效参差不齐 ,尤其胸水有分隔时则疗效更差。本文通过对 62例该类病人进行胸膜全剥脱加肺叶、全肺或肺楔形切除手术 62例 ,胸水基本消失 ,仅 3例出现中等量胸水 ,患者术前出现的剧烈胸痛消失 ,气促明显改善 ,Karnofsky计分明显提高 ,生活质量明显改善。现在一般认为 ,胸膜壁层微血管受转移肿瘤的侵犯 ,使胸水产生增多 ,而壁层胸膜淋巴孔受破坏影响胸水正常排出为胸水产生的主要原因 ,手术切除病变的胸膜 ,消除了恶性胸水产生的病因。手术前注意将胸水尽量抽干 ,术中抽胸水时要缓慢进行 ,以防复张性肺水肿发生。该手术对患者防止远处转移及提高生存率效果不明显 ,改善这方面情况 ,有赖于包括内科化疗、免疫治疗等在内的综合治疗。
Primary lung cancer with pleural metastasis, malignant pleural effusion, TNM stage is stage b lung cancer, most of the clinical symptoms of shortness of breath, chest pain, etc., generally medical treatment, mainly to the intrapleural injection of anti-inflammatory drugs, chemotherapy drugs, immune Preparations, etc., causing pleural inflammation, chemical adhesions. However, the effect is uneven, especially when pleural effusion is less effective. In this paper, 62 cases of such patients pleural exfoliation with lobectomy, pulmonary or pulmonary wedge resection in 62 cases, pleural effusion disappeared, only 3 cases of moderate pleural effusion, the patient had severe chest pain disappeared before, gas was significantly improved , Karnofsky score was significantly improved, quality of life improved significantly. It is generally believed that the invasion of pleural wall capillaries by metastatic tumors, pleural effusion increased, while the parietal pleural lymphatic pores affected by the normal discharge of pleural effusion as the main cause of pleural effusion, surgery to remove the diseased pleura, eliminating the malignant pleural effusion Etiology. Attention should be drained before surgery to pleural effusion, intraoperative pleural effusion to be carried out slowly to prevent the occurrence of reextensive pulmonary edema. The operation of patients with distant metastasis and improve the survival rate is not obvious, to improve this situation depends on including chemotherapy, immunotherapy, etc., including comprehensive treatment.