腹腔热灌注治疗恶性腹水的临床效果

腹腔热灌注治疗恶性腹水的临床效果

作者：常娜朱晓菊付文娟王帅李艳艳佟玲刘素艳

来源：《中国医药导报》2016年第23期

[摘要] 目的比较常规腹腔化疗与腹腔热灌注化疗（HIPEC）的临床疗效差异，探讨HIPEC的临床应用价值与优势。方法将2015年1月～2016年1月唐山市人民医院收治的86例患者依照治疗方式不同分为观察组（44例）及对照组（42例）。两组患者均采用常规腹膜腔穿刺方案将腹水放尽，观察组采用HIPEC疗法进行治疗，后使用四极板内生场热疗进行干预，对照组患者仅进行腹腔灌注治疗。记录HIPEC治疗时观察组患者不同时间点（治疗0、15、60 min时）生命体征及温度变化情况；比较两组患者的临床疗效、Kamofsky评分变化情况、不良反应情况。结果治疗过程中观察组患者生命体征及温度无明显变化（P > 0.05）。观察组患者临床疗效显著优于对照组（P < 0.01）；治疗前，两组患者Kamofsky评分比较差异无统计学意义（P > 0.05），治疗后两组患者Kamofsky评分均较治疗前显著升高（P < 0.01），且观察组患者评分明显优于对照组，差异有高度统计学意义（P < 0.01）；两组患者骨髓抑制、恶心呕吐、肠梗阻、脂肪硬结发生率比较差异无统计学意义（P > 0.05），但观察组患者腹痛发生率显著高于对照组（P < 0.01）。结论 HIPEC可显著提高恶性腹水治疗的临床疗效、改善Kamofsky评分，且具有较高的安全性，可作为治疗恶性腹水的有效方案在临床中推广应用。

[关键词] 腹腔化疗；腹腔热灌注化疗；恶性腹水；疗效

[中图分类号] R735.7 [文献标识码] A [文章编号] 1673-7210（2016）08（b）-0110-05

[Abstract] Objective To compare the clinical therapeutic effect of conventional intraperitoneal chemotherapy with itraperitoneal chemotherapy hyperthermic， and explore the clinical value and advantages of HIPEC. Methods Eighty-six patients admitted in the People's Hospital of Tangshan City from January 2015 to January 2016 were divided into observation group and control group according to the different treatment， and 44 cases were set as the observation group， 42 cases were set as the control group. Patients of the two groups were treated with routine peritoneal cavity puncturing scheme put the ascites， and the observation group was treated with HIPEC therapy. After using four board endogenetic field thermotherapy in intervention， patients in the control group were only treated with intraperitoneal perfusion； observation group were treated with HIPEC. Changes of life signs and temperature at different time points （treated for 0， 15， 60 min） of patients in the observation group during the HIPEC treatment record. The clinical curative effect， Karnofsky score changes， adverse reactions were compared. Results In the course of treatment life signs and temperature of patients in observation group had no significant changes （P > 0.05）. The clinical efficacy of the observation group was significantly better than that of the control group （P < 0.01）. Before treatment， the Karnofsky score between the two groups had no statistically significant difference （P > 0.05）. After treatment， Karnofsky scores of the two groups were significantly

increased compared with before treatment （P < 0.01）， and the score of the observation group was significantly better than that of the control group， the difference was statistically significant （P < 0.01）. Incidence of bone marrow suppression， nausea and vomiting， bowel obstruction， and adipose scleroma of the two groups had no statistically significant difference （P > 0.05）， but the incidence of abdominal pain of the observation group was significantly higher than that of the control group （P < 0.01）. Conclusion HIPEC can significantly improve the clinical efficacy and Kamofsky score of patients with malignant ascites， and is high security， it is worthy of clinical application for the treatment of malignant ascites.

[Key words] Intraperitoneal chemotherapy； Hyperthermic intraperitoneal chemotherapy；Malignant ascites； Curative effect

腹腔或全身恶性肿瘤极易诱发腹腔脏壁层弥漫性病变，并进一步导致患者腹腔积液异常增多，临床上将其称为恶性腹水[1]。临床研究发现，恶性腹水进展较快，患者若不进行有效干预则可能出现腹胀、腹痛等症状，甚至可能出现呼吸困难等[2]。有研究指出，恶性腹水患者预后极差，患者生存期较短，5年生存率低于35%[3]。近年来，腹腔热灌注化疗（HyperthermicItraperitoneal chemotherapy，HIPEC）是辅助腹腔恶性肿瘤治疗的有效手段，较传统化疗手段，其在治疗及预防恶性肿瘤的腹膜种植具有极其明显的临床优势[4]。因此笔者对河北省唐山市人民医院（以下简称“我院”）收治的86例恶性腹水患者进行研究，比较常规腹腔化疗与HIPEC的临床疗效差异，以期探讨HIPEC的临床应用价值与优势。

1 资料与方法

1.1 一般资料

将我院2015年1月～2016年1月收治的86例患者依照治疗方式不同分为观察组及对照组两组。其中观察组44例患者中，男23例，女21例；平均年龄（58±9）岁；平均腹水量（4170±647）mL；原发胃癌患者15例，结肠癌19例，卵巢癌10例；平均KPS评分

（69±11）分；平均整体营养状况主观评估（PG-SGA评分）（5±2）分。对照组42例患者中，男20例，女22例；平均年龄（58±10）岁；平均腹水量（4353±685）mL；原发胃癌14例，结肠癌19例，卵巢癌9例；平均KPS评分（69±10）分；平均PG-SGA评分（5±1）分。两组患者性别、年龄、腹水量、原发病、KPS评分及PG-SGA评分比较，差异均无统计学意义（P > 0.05），具有可比性。本研究经我院医学伦理委员会批准。

1.2 纳入及排除标准

纳入标准：①血常规正常；①病理检查结果证实为恶性腹水；③患者预计生存期大于3个月；④Kamofsky评分不低于60分；⑤患者及其家属对本次研究知情并签署知情同意书。排除标准：①腹水量低于1500 mL或无恶性腹水；②腹腔内广泛粘连；③采用手术方案切除肿瘤或采用姑息性减瘤术进行治疗；④患者肠梗阻或出现包裹性腹腔积液；⑤凝血功能异常。