Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, People's Republic of China.
Onco Targets Ther. 2013 May 10;6:517-21. doi: 10.2147/OTT.S41347. Print 2013.
The treatment of thymoma or thymic carcinoma with pleural dissemination remains controversial due to the unpredictable natural history of this tumor. Our study discusses the combination of cytoreductive surgery with hyperthermic intrapleural chemotherapy to treat thymoma or thymic carcinoma with pleural dissemination.
From February 2008 to January 2010, there were four patients with pleural thymoma metastases undergoing cytoreductive surgery and intrathoracic hyperthermic perfusion with chemotherapy at our department. After video-assisted thoracoscopic surgery, the hyperthermic perfusion system was set up for hyperthermic intrapleural chemotherapy. The thoracic cavity was perfused at a speed of approximately 1.8-2.3 L/min with 0.9% normal saline. The intrathoracic temperature remained between 42°C and 43°C. The perfusion process lasted for 2 hours.
There were no perioperative deaths. During the hyperthermic perfusion, the patient's core temperature varied from 36.3°C and 39.3°C and pulse varied from 59 beats/min and 126 beats/min. Intraoperative sinus tachycardia occurred in two elderly patients. No hematologic toxicity and nephrotoxicity was observed within 1 week after surgery. Postoperative pneumonia occurred in one elderly patient. Patients were followed up for 1-4 years. One elderly patient died of heart failure 1 year after surgery. There were no patients with local recurrence or metastases to distant sites.
Cytoreductive surgery and intrathoracic hyperthermic perfusion with chemotherapy may be effective in treating thymoma or thymic carcinoma with pleural dissemination and has an encouraging impact on the patients' long-term survival.
由于这种肿瘤的不可预测的自然病史，伴胸膜播散的胸腺瘤或胸腺癌的治疗仍存在争议。我们的研究讨论了细胞减灭术联合胸腔内热灌注化疗治疗伴胸膜播散的胸腺瘤或胸腺癌。
2008 年 2 月至 2010 年 1 月，我科有 4 例胸膜胸腺瘤转移患者行细胞减灭术和胸腔内热灌注化疗。在电视辅助胸腔镜手术后，建立了胸腔内热灌注系统进行胸腔内热灌注化疗。胸腔以 1.8-2.3 L/min 的速度用 0.9%生理盐水灌注，胸腔内温度保持在 42°C-43°C之间，灌注过程持续 2 小时。
无围手术期死亡。在热灌注过程中，患者的核心体温在 36.3°C-39.3°C之间变化，脉搏在 59 次/分-126 次/分之间变化。两名老年患者术中发生窦性心动过速。术后 1 周内无血液毒性和肾毒性。1 例老年患者术后并发肺炎。患者随访 1-4 年。1 例老年患者术后 1 年死于心力衰竭。无局部复发或远处转移患者。
细胞减灭术联合胸腔内热灌注化疗可能对伴胸膜播散的胸腺瘤或胸腺癌有效，并对患者的长期生存有积极影响。
