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目的 :观察培美曲塞/顺铂联合博来霉素胸腔热灌注治疗晚期肺腺癌合并恶性胸腔积液的临床疗效。方法 :将70例晚期肺腺癌合并恶性胸腔积液患者随机分成两组,每组35例,分别设为观察组和对照组。对照组患者予以培美曲塞加顺铂静脉化疗;观察组在培美曲塞/顺铂静脉化疗的基础上联合博来霉素胸腔热灌注治疗。2个疗程后,对患者进行胸腔积液肿瘤标志物(CEA、CYFRA21-1)检测;末次化疗后再次检测CEA与CYFRA21-1水平并评价疗效及毒副反应;采用KPS评分评价患者治疗后生活质量。结果 :(1)治疗前,两组CEA、CYFRA21-1水平比较无明显差异。2个疗程后,两组CEA、CYFRA21-1水平均较治疗前明显降低,观察组CEA、CYFRA21-1水平显著低于对照组。末次化疗后,两组CEA、CYFRA21-1水平均较2个疗程结束时明显更低,组间比较无明显差异。(2)胸水疗效:观察组RR(91.4%)明显高于对照组。胸膜病灶疗效:观察组RR(85.7%)明显高于对照组。(3)治疗后,观察组患者的KPS评分[(82.15±9.26)分]、总改善率(82.9%)明显高于对照组。(4)观察组主要毒副反应:消化道反应、发热和骨髓抑制;对照组主要毒副反应:消化道反应、骨髓抑制。结论 :培美曲塞/顺铂联合博来霉素胸腔热灌注治疗晚期肺腺癌合并恶性胸腔积液临床疗效好,毒副反应少而轻,能有效改善患者生活质量。
Objective: To observe the clinical efficacy of pemetrexed / cisplatin combined with bleomycin pleural hyperthermic perfusion in the treatment of advanced lung adenocarcinoma with malignant pleural effusion. Methods: Seventy patients with advanced lung adenocarcinoma with malignant pleural effusion were randomly divided into two groups (n = 35 in each group), which were divided into observation group and control group. Patients in the control group received pemetrexed plus cisplatin intravenous chemotherapy. Patients in the observation group received pemetrexed / cisplatin intravenous chemotherapy combined with bleomycin pleural heat perfusion. After 2 courses of treatment, the patients were tested for the tumor markers of pleural effusion (CEA, CYFRA21-1); the levels of CEA and CYFRA21-1 were tested again after the last chemotherapy and the curative effect and toxicity were evaluated; the KPS score was used to evaluate the patients’ life after treatment quality. Results: (1) Before treatment, there was no significant difference between the two groups in CEA and CYFRA21-1 levels. After 2 courses of treatment, the levels of CEA and CYFRA21-1 in both groups were significantly lower than those before treatment, and the levels of CEA and CYFRA21-1 in the observation group were significantly lower than those in the control group. After the last chemotherapy, the levels of CEA and CYFRA21-1 in both groups were significantly lower than those at the end of the two courses, with no significant difference between the two groups. (2) Pleural Efficacy: The observation group RR (91.4%) was significantly higher than the control group. Pleural lesions efficacy: observation group RR (85.7%) was significantly higher than the control group. (3) After treatment, the KPS score of the observation group [(82.15 ± 9.26) points], the total improvement rate (82.9%) was significantly higher than that of the control group. (4) The main side effects of the observation group: digestive tract reaction, fever and myelosuppression; the main side effects of the control group: digestive tract reaction, bone marrow suppression. Conclusion: Pemetrexed / cisplatin combined with bleomycin pleural heat perfusion in the treatment of advanced lung adenocarcinoma with malignant pleural effusion has good curative effect, less toxic and side effects, and can effectively improve the quality of life of patients.