超声引导射频消融联合胸腔靶向灌注对肺癌恶性胸腔积液的疗效及生存质量的影响

doi:10.3969/j.issn.1005-6483.2021.04.019

摘要/Abstract

摘要： 目的：分析超声引导射频消融胸膜转移瘤对非小细胞肺癌相关恶性胸腔积液的疗效及生存质量的影响。方法：2018年4月～2020年4月因非小细胞肺癌合并恶性胸腔积液于我院住院治疗病人101例，按照双盲随机数分组法分为联合治疗组36例例，采用超声引导射频消融联合胸腔靶向灌注；胸腔灌注治疗组30例，采用胸膜腔靶向灌注贝伐珠单抗治疗；射频消融组35例，采用超声引导射频治疗。比较3组病人治疗前后肿瘤指标(CEA、CA125、血管内皮生长因子表达)、恶性胸腔积液无进展生存时间、疼痛评分及生活质量评分。〖HTH〗结果〓〖HTSS〗3组病人治疗后肿瘤指标CEA及CA125均有下降，差异有统计学意义(P<0.05)。联合治疗组及胸腔灌注治疗组治疗后血管内皮生长因子表达下降，差异有统计学意义(P<0.05)。联合治疗组无进展生存时间长于胸腔灌注治疗组、射频消融组，差异有统计学意义(P<0.05)。联合治疗组及射频消融组治疗后VAS疼痛评分及生活质量评分明显改善，差异有统计学意义(P<0.05)。3组病人治疗后均未出现3/4级严重治疗不良反应。结论：超声引导射频消融联合胸腔靶向灌注治疗，能改善病人无进展生存时间，下调血管内皮生长因子表达，改善病人生存质量。

关键词: 胸腔积液, 超声引导, 射频消融, 胸腔灌注, 无进展生存时间, 生活质量评分, 疼痛评分

Abstract: Objective：To analyze the efficacy and quality of life of ultrasoundguided radiofrequency ablation of pleural metastases in the treatment of nonsmall cell lung cancer associated malignant pleural effusion.Method：The 101 patients with nonsmall cell lung cancer complicated with malignant pleural effusion were collected from April 2018 to April 2020.According to the doubleblind random number grouping method,the patients were divided into combined treatment group(ultrasound guided radiofrequency ablation combined with targeted thoracic perfusion,n=36),thoracic perfusion treatment group(n=30) and radiofrequency ablation group(n=35).In the radiofrequency ablation group,ultrasoundguided radiofrequency therapy was used;in the thoracic perfusion treatment group,targeted perfusion of bevacizumab into pleural cavity was used;and in the combined treatment group,ultrasoundguided radiofrequency therapy combined with local targeted pleural perfusion was used.The changes of tumor indexes(CEA,CA125,vascular endothelial growth factor expression),progression free survival time,pain score and quality of life score of patients with malignant pleural effusion before and after treatment were compared and analyzed.Result：The tumor markers CEA and CA125 of three groups of patientswere significantly decreased after treatment,the difference was statistically significant(P<0.05).The vascular endothelial growth factor decreased significantly in the combined treatment group and the thoracic perfusion treatment group after treatment,the difference was statistically significant(P<0.05).The progression free survival time of the combined treatment group was longer than that of the thoracic perfusion treatment group and the radiofrequency ablation group(P<0.05).After treatment,the VAS pain score and quality of life score improved significantly in the combined treatment group and the radiofrequency ablation group(P<0.05).There were no grade 3/4 serious side effects in the three groups after treatment.Conclusion：The ultrasound guided radiofrequency ablation combined with targeted thoracic perfusion therapy can improve the progression free survival time,down regulate the expression of vascular endothelial growth factor,and improve the quality of life of patients.

Key words: pleural effusion, ultrasound, radiofrequency ablation, thoracic perfusion, progression free survival time, growth quality score, pain score

沈柏儒, 宋长山, 吴旭辉等. 超声引导射频消融联合胸腔靶向灌注对肺癌恶性胸腔积液的疗效及生存质量的影响[J]. 临床外科杂志, 2021, 29(4): 363-366.

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