摘要目的 观察活性炭吸附顺铂胸腔内给药对癌性胸水的治疗效果并探讨其作用机制.方法 ①以2004年至2007年常州第三医院及常州第二医院放射介入科经病理学或细胞学确诊的恶性胸腔积液60例患者为研究对象,随机分为治疗组和对照组各30例.胸腔插管放尽胸水后治疗组注入顺铂和活性炭,时照组仅注入顺铂,每周B超探查确定是否重复上述治疗,但累计不超过4次.1个月后比较2组间的疗效及不良反应.②上述2组中各随机选20例,在放尽胸水后但给药前用99Tcm-DX行SPECT全身及胸部淋巴平面显像,结果 异常者于上述治疗后2周再次淋巴显像,自身前后时照观察其变化.结果 ①治疗组总有效率显著高于对照组[100%(30/30)比66.7%(20/30),χ212.00,P<0.01]并且绝大部分只需治疗1次;胃肠反应、白细胞下降率低于对照组[分别为16.7%(5/30)比30.0%(9/30),6.7%(2/30)比20.0%(6/30)],但差异无统计学意义(χ2分别为1.49和1.30,P>0.05).②治疗组淋巴显像改善率显著高于对照组[78.6%(11/14)比37.5%(6/16),P<0.05].结论活性炭吸附顺铂胸腔内给药治疗癌性胸水效果显著、安全,对淋巴引流有明显改善作用.

abstractsObjective To evaluate the therapeutic effect and possible mechanism of intrapleural administra-tion of cisplatin bound to activated carbon particles for treating malignant pleura] effusions(MPE). Methods ①60 patients with MPE confirmed in the Third Hospital of Changzhou and the Second Hospital of Changzhou from 2004 to 2007 were randomly divided into treatment group (n=30)and control group(n=30). Chest catheters were inserted percutaneously into the pleural space to drain the effusions. Cisplatin mixed with activated carbon particles for the treatment group and only cisplatin for the control group were injected into pleural cavity. Whether above-mentioned treatment should be repeated was determined by ultrasonic B every week until up to four times. Curative effect and side-effect were compared between two groups a month later. ②20 cases, randomly selected from both groups respectively, underwent whole body and chest SPECT scan to image lymphatic system by means of 99Tcm-DX after effusions drainage but before intrapleural injection of drug. Cases whose imaging graphics were abnormal would undergo the above SPECT again 2 weeks after intrapleural injection of drug so as to find changes in imaging graphics. Results ① The overall response rate was significantly higher in treatment group than in control group(100% (30/30) vs 66.7% (20/30), χ2=12.00, P<0.01)and that intrapleural injection was needed only once in most cases. Gastrointestinal upset and leucoponia were less and milder in treatment group than in control group (16.7% (5/30) vs 30.0% (9/30) and 6.7% (2/30) vs 20.0% (6/30) respectively),but there was no statistical difference between the two groups(χ2=1.49 and 1.30,P>0.05). ②The rate of improvement in lymphatic imaging was significantly higher in treatment group than in control group (78.6% (11/14) vs 37.5% (6/16),P<0.05). Conclusion The treatment of malignant pleural effusions with intrapleural administration of cisplatin bound to activated carbon particles is extremely effective and safe, and can improve lymphatic drainage as well.