Hu Runlei, Jiang Hong, Li Hu, Wei Dongshan, Wang Guoqing, Ma Shenglin
Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China.
Department of Radiation Oncology, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou 310006, China.
J Thorac Dis. 2017 May;9(5):1317-1321. doi: 10.21037/jtd.2017.04.65.
The aim of this study was to assess the effectiveness of intrapleural perfusion thermo-chemotherapy (IPTC) under video-assisted thoracoscopic surgery (VATS) for malignant pleural effusion (MPE) caused by lung carcinoma.
In this retrospective study, fifty-four patients with moderate or large amounts of ipsilateral MPE secondary to non-small cell lung cancer (NSCLC) underwent pleural biopsy and IPTC under VATS. IPTC was performed by perfusing the pleural cavity with 43.0 °C saline solution containing cisplatin (200 mg/m) using a devised circuit through mechanical circulation for 60 minutes. Blood pressure, heart rate, oxygen saturation (SpO), and esophageal and rectal temperatures were monitored throughout the surgery. At the end of the perfusion, pleural biopsy was performed again for histological analysis.
The temperature at the pleural surface was stabilized at 43 °C, and pleural effusion was controlled in all patients. KPS scores increased in 89.3% of patients. No patient developed bone marrow suppression reactions with noticeable bleeding after treatment, and no liver and kidney malfunctions were observed. Apoptosis was detected by light and electron microscopy after IPTC. CEA markedly decreased in all patients 1 month after IPTC. The median survival time was 21.7 months, with a one-year survival rate of 74.1%.
IPTC under VATS is a new, safe, less invasive and more effective approach for MPE caused by lung carcinoma.
本研究旨在评估电视辅助胸腔镜手术（VATS）下胸膜腔内灌注热化疗（IPTC）治疗肺癌所致恶性胸腔积液（MPE）的有效性。
在这项回顾性研究中，54例因非小细胞肺癌（NSCLC）导致同侧中量或大量MPE的患者接受了VATS下的胸膜活检和IPTC。IPTC通过使用设计的循环装置经机械循环向胸腔内灌注含顺铂（200 mg/m）的43.0℃生理盐水60分钟来进行。在整个手术过程中监测血压、心率、血氧饱和度（SpO）以及食管和直肠温度。灌注结束时，再次进行胸膜活检以进行组织学分析。
胸膜表面温度稳定在43℃，所有患者的胸腔积液均得到控制。89.3%的患者KPS评分提高。治疗后无患者发生骨髓抑制反应及明显出血，未观察到肝肾功能异常。IPTC后通过光镜和电镜检测到细胞凋亡。IPTC后1个月所有患者的癌胚抗原（CEA）均显著下降。中位生存时间为21.7个月，1年生存率为74.1%。
VATS下的IPTC是一种治疗肺癌所致MPE的新的、安全的、侵入性较小且更有效的方法。
