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目的探讨提高肺热循环灌注质量的技术要点。方法 2005年10月至2015年6月我院42例(男23例、女19例,年龄32~78岁)恶性胸腔积液患者在电视胸腔镜下行胸膜活检后行肺热循环灌注治疗。采用体外循环机灌注12例,专用热循环灌注机16例,自行设计简易循环灌注法14例,病理检查明确为胸膜转移癌后以43℃0.9%Na Cl与50 mg顺铂溶液循环胸腔热灌注60 min,随访观察胸腔积液的有效控制率、不良反应、患者的生活质量以及生存期。结果电视胸腔镜下胸膜活检诊断阳性率达100.0%,细胞学检查诊断阳性率为26.2%。全组胸腔积液控制总有效率为96.5%,完全缓解率为86.7%,部分缓解率为9.8%,无效率为3.5%。3例分别于热灌注治疗后4、6、11个月胸腔积液复发,其余均无胸腔积液复发。39例患者热灌注治疗后生活质量明显提高,Karnofsky行为评分超过80分。全组中位生存期为17.5个月,1年生存率为89.3%,其中7例生存3年以上。手术顺利,除1例切口皮下溢液外无明显并发症和手术死亡。结论影响灌注质量的因素有肿瘤大小、肺复张程度、切口选择、灌注持续温度、胸腔灌注平面的控制、灌注管口径长度、流量控制、灌注技巧、引流管留置方法。主要防范并发症有切口皮下溢液,出血、发热,术后残腔等。
Objective To explore the technical points to improve perfusion quality of pulmonary thermo-circulation. Methods From October 2005 to June 2015, 42 patients (23 males and 19 females, aged 32-78 years) with malignant pleural effusion underwent pleural biopsy after video-assisted thoracoscopic surgery. 12 cases were perfused by cardiopulmonary bypass and 16 cases were treated by special thermal cycle perfusion machine. 14 cases were designed by simple percutaneous perfusion. The pathological examination was performed after pleural metastasis, Sixty minutes after operation, the effective rate of pleural effusion, adverse reactions, quality of life and survival of patients were observed. Results Video-assisted thoracoscopic pleural biopsy showed a positive rate of 100.0%. The positive rate of cytology was 26.2%. The total effective rate of the control group was 96.5%, the complete remission rate was 86.7%, the partial remission rate was 9.8% and the inefficiency rate was 3.5%. Three cases were recurrent pleural effusion at 4, 6, and 11 months after thermal perfusion treatment, respectively. No recurrence of pleural effusion was found in the remaining 3 cases. The quality of life was significantly improved in 39 patients after thermal perfusion, with a Karnofsky Behavioral Score exceeding 80. The median survival time was 17.5 months, and the 1-year survival rate was 89.3%. Of these, 7 patients survived for more than 3 years. The operation was smooth, except for 1 case of incision subcutaneous discharge without obvious complications and surgical death. Conclusion The factors affecting the quality of perfusion are tumor size, degree of pulmonary recanalization, choice of incision, continuous perfusion temperature, control of pleural perfusion plane, length and diameter of perfusion tube, flow control, perfusion technique and drainage tube indwelling method. The main prevention of complications incision subcutaneous discharge, bleeding, fever, postoperative residual cavity.