2018洛铂联合腹腔热灌注治疗癌性腹水的临床探讨
[摘要] 目的 探讨洛铂联合腹腔热灌注治疗癌性腹水的疗效。 方法 方便该院2016年2月―2017年2月收治的57例癌性腹水患者，随机分为2组，试验组25例抽腹水后腹腔内热灌注洛铂50 mg，1次/周，连续4～8周。对照组22例采用单药顺铂60 mg传统腹腔内灌注，1次/周，连续4～8周。观察两组治疗前后癌性腹水消退情况及KPS评分变化，并比较两组不良反应。结果 试验组治疗有效率80.0%；KPS评分提高16例，稳定6例，降低3例。对照组治疗有效率为45.5%，KPS评分提高6例，稳定11例，降低5例。比较2组疗效，试验组优于对照组（P http://[关键词] 肿瘤；癌性腹水；热灌注；洛铂；顺铂
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2017）10（c）-0150-03
Clinical Study on Treatment of Cancerous Ascites with Lobaplatin Combined with Intraperitoneal Hyperthermic Perfusion
LI Quan， LIN Zhi-jie， HONG Yan-mei， REN Jie
Department of Oncology， People’s Hospital Affiliated to Quanzhou Medical College， Quanzhou， Fujian Province， 362000 China
Objective This paper tries to investigate the curative effect of lobaplatin combined with intraperitoneal hyperthermic perfusion in the treatment of malignant ascites. Methods 57 cases of malignant ascites treated in this hospital from Feburary 2016 to Feburary 2017 were convenient selected and randomly divided into two groups， 25 cases of the experimental group adopted intraperitoneal hyperthermic perfusion of lobaplatin 50 mg after hyperthermic， for once a week， with 4 to 8 weeks. 22 cases in the control group adopted the traditional single agent cisplatin intraperitoneal infusion of 60 mg， for once a week， with 4 to 8 weeks. The changes of cancerous ascites and KPS scores were observed before and after treatment， and the adverse reactions were observed. Results The effective rate of the treatment group was 80.0%；KPS score increased to 16 cases， 6 cases were stable， 3 cases decreased. The effective rate of the control group was 45.5%，KPS score increased in 6 cases， 11 cases were stable， 5 cases decreased. After comparison of the curative effect in the two groups， the experimental group was better than that of the control group（P理学确诊。经统计学处理，2组患者一般情况差异无统计学意义（P>0.05），具有可比性，见表1。 1.2 治疗方法
体腔热灌注机为和佳公司生产的型号HGGZ-102体腔热灌注治疗机。洛铂为贵州益佰有限公司生产，每支10 mL。患者在B超引导下定位，一般取右侧麦氏点为穿刺点，采用中心静脉导管引流术，沿着腹腔内壁与升结肠旁隙向上埋管，然后把药袋灌注管与中心静脉导管连接好，即完成进水管的埋管；腹部左侧髂前上棘上2 cm处，中心静脉导管由此进入，管口向下埋到直肠膀胱凹陷处（女性为直肠子宫凹陷处），此为腹腔最低点便于引流，然后把药袋引流管与其连接好，即完成出水管的埋管。用药前尽量引流尽腹水。试验组预先将洛铂50 mg加生理盐水1000 mL，灌入一次性灌注药袋里混合均匀。用仪器感应式微波加热系统加热腹水及稀释化疗药液混合液，设定温度在42～44°C。先将腹水引流药袋中，再将加热的混合液灌注到腹腔内，通过进水管和出水管循环灌注，治疗时间一般为60 min。对照组腹腔置管后尽量引流尽腹水后灌注顺铂60 mg加生理盐水1 000 mL。两组注药前都给予托烷斯琼预防呕吐。腹腔灌注后1 h嘱患者每15 min翻身1次，增大腹膜与?物接触面积。2组治疗前后均检查B超及生活质量观察，每周复查血常规，肝肾功能。腔内灌注每周1次，视腹水情况连用4～8周，2组病例最少用2周，最多用8周。试验组25例，总灌注周数157周，中位时间数6周；对照组22例，总灌注周数130周，中位时间6周。
1.3 疗效评价标准
①通过B超测量按WHO标准评价癌性腹水消退。完全缓解（CR）：症状明显缓解或消失，癌性腹水消失且维持时间>4周；部分缓解（PR）：症状明显改善，癌性腹水减少>50%，且维持时间>4周；无变化（NC）：癌性腹水减少未达到50%；进展（PD）：症状加重，癌性腹水增加。有效率以CR+PR统计。②按Karnofsky（KPS）评分法统计治疗后生活质量状况。改善：治疗后评分增加≥10分；降低：治疗后评分减少≥10分；稳定：评分较治疗前增加或减少
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