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目的观察亚砷酸胸腔内灌注联合体外高频热疗对癌性胸水的疗效。方法连续纳入45例癌性胸水病例,采用抽签法分为A、B、C 3组。所有患者均尽量引流胸水(至引流量小于150 m l/d),A组经导管向胸腔内灌注亚砷酸20 mg,后拔除导管并于当日行胸腔局部热疗1次,以后隔日热疗1次,连续4次;B组仅予胸腔内灌注亚砷酸20 mg并拔除导管;C组于胸水引净后拔除导管,并于当日行胸腔局部热疗1次,以后隔日热疗1次,连续4次。在拔管4周后复查胸水量,观察3种方法对癌性胸水的疗效及毒性反应。结果治疗后A、B、C 3组有效率分别为86.7%,62.5%和50.0%,A组胸水疗效优于B组和C组(P<0.05)。治疗后3组胸水LDH均较各组治疗前升高,均有显著性差异(P<0.01,P<0.05),以A、B两组胸水LDH升高明显。治疗后A、B两组胸水CEA均较各组治疗前降低,均有显著性差异(P<0.01),以A组胸水CEA下降明显。治疗后3组患者均未出现血液学、心脏、肝脏、肾脏等毒性反应。结论亚砷酸胸腔内灌注联合体外高频热疗控制癌性胸水具有协同增效作用,毒副反应小,患者易于耐受。
Objective To observe the curative effect of arsenious acid intrathoracic perfusion combined with external high frequency hyperthermia on cancerous pleural effusion. Methods 45 consecutive cases of cancerous pleural effusion were enrolled in this study. The patients were divided into groups A, B and C by random selection. All patients were treated with drainage of pleural effusion (to less than 150 ml / d). In group A, 20 mg of arsenious acid was intrapleurally infused into the thoracic cavity. After removal of the catheter and local thoracic hyperthermia on the same day, The patients in group B were only given thoracic arsenious acid 20 mg and catheter was removed. In group C, catheters were removed after pleural effusion and local thoracic hyperthermia was performed on the same day, followed by hyperthermia every other day, 4 times in a row After 4 weeks of extubation, the amount of pleural fluid was reviewed, and the efficacy and toxicity of the three methods on cancerous pleural effusion were observed. Results After treatment, the effective rates of A, B and C 3 groups were 86.7%, 62.5% and 50.0% respectively. The pleural effusion in group A was better than that in group B and C (P <0.05). After treatment, LDH in all three groups were significantly higher than those before treatment in each group (P <0.01, P <0.05). LDH in both pleural effusions in groups A and B increased significantly. After treatment, the CEA of pleural effusion in both groups A and B were significantly lower than those in each group before treatment (P <0.01), and CEA of pleural effusion in A group decreased significantly. After treatment, there were no hematological, cardiac, liver, kidney toxic reactions in the three groups. Conclusions Intrapleural infusion of arsenious acid in combination with high frequency hyperthermia in vitro has synergistic effect on the control of cancerous pleural effusion. The toxic side effects are small and patients are easily tolerated.