doi 1013241jcnkipmb201601019
腹腔灌注化疗联合生场热疗治疗胰腺癌恶性腹水疗效
周欣峰 1 姬舒荣 1△ 陈中皓 2 孙 超 2 俞 阳 2
(1 济学医学院血外科 海 2000612 海交通学医学院附属仁医院 海 200050)
摘 目:探讨腹腔灌注化疗联合生场热疗治疗胰腺癌恶性腹水床疗效方法: 50 例晚期胰腺癌合恶性腹水患者
机分实验组组组 25 例实验组行腹腔灌注化疗联合生场热疗治疗组单纯行腹腔灌注化疗较两组患者腹
水控制疗效生活质量改善疼痛程度良反应情况结果:实验组患者治疗腹水控制总效率 680明显高组
360(P<005)实验组生活质量改善率达 600远高组 400(P<005)实验组患者疼痛水明显组(P<0
05)两组患者良反应发生率明显差异(P>005)结:腹腔灌注化疗联合生场热疗治疗胰腺癌恶性腹水效果显著明显
改善患者生活质量缓解疼痛值床推广
关键词:腹腔灌注化疗生场热疗胰腺癌恶性腹水效果
中图分类号:R7359 文献标识码:A 文章编号:16736273(2016)018803
Effect of Intraperitoneal Chemotherapy Combined with Endogenetic Field
Thermotherapy in the Treatment of Malignant Ascites and Pancreatic Cancer
ZHOU Xinfeng1 JI Shurong1△ CHEN Zhonghao2 SUN Chao2 YU Yang2
(1 Department of Vascular Surgery Medical College of Tongji University Shanghai 200061 China
2 Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai 200050 China)
ABSTRACT Objective To explore the effect of intraperitoneal chemotherapy combined with endogenetic field thermotherapy in the
treatment of malignant ascites and pancreatic cancer Methods Divided 50 patients with advanced malignant ascites and pancreatic can
cer randomly into experiment group and control group with 25 patients in each group The experiment group was treated with intraperi
toneal chemotherapy combined with endogenetic field thermotherapy while the control group was only was treated with intraperitoneal
chemotherapy Compared the effect of ascites control improvement rate of life quality pain degree and the incidence of adverse reaction
Results The total effective rate of ascites control in the experiment group was 680 which was significantly higher than 360 in control
group (P<005) The improvement rate of life quality in experiment group was 60 which was significantly higher than 40 in control
group(P<005) The pain degree in experiment group was significantly better than control group(P<005) The incidence of adverse reac
tion in two groups was no significant difference Conclusion Intraperitoneal chemotherapy combined with endogenetic field thermotherapy
has great effect in the treatment of malignant ascites and pancreatic cancer it can significantly improve the life quality and relieve pain
which is worth of clinical promotion
Key words Intraperitoneal chemotherapy Endogenetic field thermotherapy Pancreatic cancer Malignant ascites Effect
Chinese Library Classification(CLC) R7359 Document code A
Article ID 16736273(2016)018803
作者简介:周欣峰(1984)男科治医师事肝胆胰肿瘤治
疗方面研究Email:287861231@qqcom
△通讯作者:姬舒荣(1970)男博士副医师副教授事
胃肠道恶性肿瘤外科综合治疗方面研究
(收稿日期:20150611 接受日期:20150630)
前言
恶性腹水恶性腹腔积液胰腺癌晚期极容易出现
发症严重威胁患者生命[1]时量腹水容易引发患者呼吸困
难肢水肿严重影响患者日常活动患者身心造成严重损
害着医疗水提高床发现消恶性腹水够明显改
善患者生活质量助采抗肿瘤治疗措施实施
患者生存时间效延长[23]目前生场热疗具
安全性高毒副反应少时具定生物免疫调节特点
具放化疗协调增效作已逐步应恶性腹水治疗
中[46]院采腹腔灌注化疗联合生场热疗治疗胰腺癌恶性
腹水取较效果现报道
1 资料方法
11 般资料
选取院 2013 年 2 月 2014 年 12 月间收治 50 例晚
期胰腺癌合恶性腹水患者作研究象患者均病理
学确诊胰腺癌行 B 超 CT 影学检查证实量腹腔积
液中 30 例患者腹水中找癌细胞20 例未找癌细胞
排非癌性腹水男性 34 例女性 16 例年龄 4270
岁均年龄(5650±235)岁卡氏评分(KarnofskyKPS)≥
50视觉模拟评分法(Visual Analogue ScaleScoreVAS) 轻度
88· ·现代生物医学进展 wwwshengwuyixuecom Progress in Modern Biomedicine Vol16 NO1 JAN2016
疼痛患者 12 例中度疼痛 28 例重度疼痛 10 例预计生存时
间>3 月月未予静脉放化疗血常规心电图检查基
正常腹腔灌注化疗生场热疗治疗禁忌症采完全
机化法患者分实验组组组 25 例中实验
组男 18 例女 7 例年龄 4269 岁均年龄(5751±258)岁
VAS 疼痛程度:轻度 7 例中度 13 例重度 5 例组男 16
例女 9 例年龄 4370 岁均年龄(5589±302)岁VAS 疼
痛程度:轻度 5 例中度 15 例重度 5 例两组患者性年龄
VAS 疼痛分级较差显著性(P>005)具性
患者家属知情意签订知情意书
12 治疗方法
实验组患者予腹腔灌注化疗联合生场热疗治疗:患
者穿刺部位皮肤予常规消毒行腹腔穿刺置引流负压
引流量腹水引流干净患者出现明显适准
予铂 40 mgm2+5 氟尿嘧啶 500 mgm2+ 塞米松 10 mg+ 生
理盐水 1000 mL 进行腹腔灌注求患者时变换体位便化
疗药物充分扩散灌注半时确保患者身金属物品
前提生场热疗系统腹腔进行热疗温度控制
4143℃周热疗 2 次次 1 时持续 4 周组予
铂 40 mgm2+5 氟尿嘧啶 500 mgm2+ 塞米松 10 mg+ 生理
盐水 1000 mL 单纯腹腔灌注化疗治疗频次疗程实验组相
13 观察指标
两组患者治疗前腹水量KPS 评分VAS 疼痛评分进
行测量记录时患者治疗出现良反应进行记录统
计
14 疗效评价
(1)恶性腹水疗效评价采 Srtowks 评定标准[7]:治疗腹
水完全消失症状消维持 1 月完全缓解治疗腹
水减少 1 2 症状明显改善维持 1 月抽液
部分缓解治疗腹水继续迅速产生减少 1 2 症状
未改善1 月需次抽液效治疗效率 (完全
缓解 + 部分缓解) 治疗总例数×100(2)KPS 评分评价患者
生活质量改善状况[8]KPS 治疗分值较治疗前提高 10 分
改善增加减少 10 分稳定减少 10 降
15 统计学方法
SPSS190 分析计数资料采 x2 检验等级资料采
秩检验P<005 表示差异具统计学意义
2 结果
21 两组患者腹水控制效果较
实验组患者治疗腹水控制总效率 680(1725)明
显高组 360(925)两组疗效较差具显著性
(x25128P0024)详见表 1
表 1 两组患者腹水控制效果较[n()]
Table 1 Comparison of the total effective rate of ascites control in two groups[n()]
组
Groups
n
完全缓解
Complete remission
部分缓解
Partial remission
效
Invalid
总效率
Total effective rate
实验组 Experiment group 25 4(160) 13(520) 8(320) 17(680)
组 Control group 25 1(40) 8(320) 16(64) 9(360)
22 两组患者生活质量改善状况较
实验组生活质量改善率达 600(1525)远高组
400(1025)(x25094P0024)详见表 2
表 2 两组患者生活质量改善较[n()]
Table 2 Comparison of the improvement rate of life quality in two groups[n()]
组 Groups n 改善 Improvement 稳定 Stable 降 Decline
实验组 Experiment group 25 15(600) 7(280) 3(120)
组 Control group 25 10(400) 5(200) 10(400)
23 两组患者治疗 VAS 疼痛水较
两组患者治疗前疼痛评价分布相似(P>005)治疗实验
组组患者疼痛分布较治疗前出现明显变化 (分 F11
5898393P00030015)轻度疼痛数例均升
组重度疼痛数升两组患者治疗 VAS 疼痛水
存显著差异(F7089P0029)详见表 3
表 3 两组患者治疗 VAS 疼痛水较[n()]
Table 3 Comparison of VAS pain degree in two groups after treatment[n()]
组 Groups 时间 Time 轻度 Mild 中度 Moderate 重度 Severe
实验组 Experiment group
治疗前 Before 7(280) 13(520) 5(200)
治疗 After 19(760) 4(160) 2(80)
组 Control group
治疗前 Before 5(200) 15(600) 5(200)
治疗 After 11(440) 5(200) 9(360)
24 两组治疗良反应较
两组患者均出现化疗常见恶心呕吐骨髓抑制等良反
应实验组恶心 2 例骨髓抑制 1 例良反应发生率 12
(325)组恶心 2 例呕吐 1 例骨髓抑制 2 例良反应发
生率 20(525)两组良反应发生率显著差异(P>005)
89··现代生物医学进展 wwwshengwuyixuecom Progress in Modern Biomedicine Vol16 NO1 JAN2016
3 讨
恶性腹水恶性肿瘤中晚期常见发症床常
放化疗中西医联合治疗腹腔引流灌注化疗生物反应调
节剂治疗方式予治疗均存定局限性[911]年
腹腔灌注化疗联合生场热疗逐渐成新兴治疗恶性肿瘤
导致恶性腹水方法作机制:腹腔灌注化疗通
化疗药物直接注入腹腔提高化疗药物腹腔游离肿瘤细
胞作浓度时腹膜 血浆屏障作腹腔药物浓
度保持相稳定进步发挥药物杀灭肿瘤细胞活性[1213]
研究发现腹腔化疗药物浓度血药浓度数倍
数十倍明显强化抗肿瘤药物靶作[14]
目前腹腔灌注化疗药物铂氟尿嘧啶丝裂霉素
等单纯腹腔灌注化疗药物肿瘤组织穿透力
限腹腔肿瘤细胞难实现彻底杀灭治疗中需
配合开展生场热疗[1517]研究发现恶性肿瘤予生场热
疗作机理肿瘤细胞热源敏感热疗产生高热
够抑制肿瘤细胞 DNA 修复药耐药性 P 糖蛋白表达
增强癌细胞化疗药物敏感性减少逆转肿瘤耐药性
发生时热源促进肿瘤血扩张加快血液循环肿瘤组
织化疗药物浓度增加降低肿瘤细胞 VEGF 合成分泌破
坏减少肿瘤血生发挥抑制肿瘤增殖作[1820]研究
采腹腔予铂 40 mgm2+5 氟尿嘧啶 500 mgm2+ 塞米
松 10 mg+ 生理盐水 1000 mL 灌注化疗联合生场热疗治疗胰
腺癌恶性腹水期控制腹水效率达 680远高单
纯予腹腔灌注化疗 36进步证实腹腔灌注化疗联合
生场热疗治疗胰腺癌恶性腹水中发挥协效应时
KPS 评分结果提示予腹腔灌注化疗联合生场热疗治疗
明显改善患者生活质量 VAS 检测提示患者疼痛水
效减轻两组良反应发生率显著差异说明腹腔灌
注化疗联合生场热疗预效果远单独腹腔灌注化
疗会增加患者发生良反应风险
综腹腔灌注化疗联合生场热疗治疗胰腺癌恶性腹水
效果显著明显改善患者生活质量缓解疼痛值床推广
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