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目的:总结和分析我科收治的5例伴有恶性心包积液的晚期肺癌急诊入院患者采用心包内置管分次引流后注射顺铂和香菇多糖治疗的经过和预后,以探索此类疾病有效的治疗方法。方法:5例伴有恶性心包积液的晚期肺癌患者入院时均有心包填塞症状和体征且病情较重,其中1例处于全心衰竭、循环衰竭状态。入院后所有患者均及时接受心包置管分次引流后心包内注射顺铂和香菇多糖,并进行相应的后续治疗和随访。结果:5例患者经心包内置管引流和心包内药物注射后心包填塞症状和体征均有不同程度好转,获得完全缓解(CR)3例、部分缓解(PR)1例,进展(PD)1例。随访结果表明:5例患者均因癌症未能得以控制而进一步恶化死亡,其中3例死于肺癌所致气道阻塞、呼吸衰竭,另2例死于恶病质。心包积液获得CR的3例患者(曾继续接受多次不同方案的化疗)存活时间分别为10个月、18个月和19个月,而且有2例至死前再未见有心包积液症状、体征和影像学证据。结论:本组资料结果提示,对于伴有恶性心包积液的晚期肺癌,即使病情处于终末期,实施积极的治疗措施仍有可能控制病情,从而获得生活质量的提高和生存期延长。心包内置管分次引流后注射顺铂和香菇多糖则不失为一种有效的方法,值得进一步在更多的此类病例中验证。
OBJECTIVE: To summarize and analyze the treatment and prognosis of 5 advanced lung cancer patients with malignant pericardial effusion undergoing percutaneous transluminal pericardial catheterization after cisplatin and lentinan treatment in order to explore the effective of these diseases treatment method. Methods: Five cases of advanced lung cancer with malignant pericardial effusion had symptoms and signs of pericardial tamponade at admission, and the condition was severe. One of them was in full-heart failure and circulatory failure. After admission, all patients received timely pericardial catheter drainage and pericardial injection of cisplatin and lentinan, followed by follow-up and follow-up. Results: The symptoms and signs of pericardial tamponade were improved in 5 patients after pericardial internal drainage and pericardial drug injection. There were 3 cases of complete remission (CR), 1 case of partial remission (PR) and 1 case of progression (PD) . The follow-up results showed that all 5 patients died of further deterioration due to the failure of cancer control. Three of them died of airway obstruction caused by lung cancer and respiratory failure, and the other two died of cachexia. Pericardial effusion obtained in 3 patients with CR (who have continued to receive multiple chemotherapy regimens) survival time was 10 months, 18 months and 19 months, and 2 patients died before no see pericardial effusion Symptoms, signs and imaging evidence. CONCLUSIONS: The data in this study suggest that aggressive treatment of advanced lung cancer with malignant pericardial effusion may still lead to control of the condition, leading to improved quality of life and prolonged survival, even when the condition is in the final stage. Injections of cisplatin and lentinan after subcutaneous drainage of the pericardial internal tube are an effective method and worthy of further validation in more of these cases.