恒温腹腔热灌注化疗联合全身静脉化疗治疗恶性腹水的效果及安全性

张扬 钱洪 程小飞

[摘要]目的 探讨恒温腹腔热灌注化疗（HIPEC）联合全身静脉化疗治疗恶性腹水的效果及安全性。方法 选取2015年6月～2018年5月我院收治的80例恶性腹水患者，利用随机数字表法分为观察组与对照组，每组40例，对照组给予全身静脉化疗治疗，观察组在对照组基础上给予恒温HIPEC治疗，比较两组治疗效果。结果 观察组总有效率为95.00%，高于对照组的80.00%，差异有统计学意义（P<0.05）;观察组治疗后生活质量量表中生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康评分均高于对照组，差异有统计学意义（P<0.05）;两组毒副反应发生率比较，差异无統计学意义（P>0.05）。结论 恒温HIPEC联合全身静脉化疗治疗恶性腹水安全有效。

[关键词]恶性腹水;腹腔热灌注化疗;静脉化疗;毒副反应;生活质量

[中图分类号] R735          [文献标识码] A          [文章编号] 1674-4721（2020）6（b）-0099-04

[Abstract] Objective To explore effect and safety of homothermal hyperthermic-itraperitoneal chemotherapy （HIPEC） combined with systemic intravenous chemotherapy （SIC） in treatment of malignant ascites. Methods Eighty malignant ascites patients admitted to our hospital from June 2015 to May 2018 were enrolled. They were divided into observation group and control group by random number table method， 40 cases in each group. The control group was treated with SIC. On this basis， observation group was treated with homothermal HIPEC. The treatment effect was compared between the two groups. Results The total efficiency rate in observation group was higher than that in control group （95.00% vs. 80.00%） （P<0.05）. After treatment， in terms of quality of life scale， scores of physical function， physical role， physical pain， overall health， vitality， social function， emotion role and mental health were higher in observation group than those in control group （P<0.05）. There was no significant difference in incidence of toxic and side effect between the two groups （P>0.05）. Conclusion Homothermal HIPEC combined with SIC is safe and effective for malignant ascites.

[Key words] Malignant ascites; HIPEC; Intravenous chemotherapy; Toxic and side effect; Quality of life

恶性腹水是癌症晚期的并发症之一，指全身或腹腔的恶性肿瘤或癌性病变引起腹腔脏壁层胸腹膜发生弥漫性病变而导致体腔液体异常增多的现象，通常提示已有远处转移，患者预后较差[1]。恶性腹水形成机制至今尚不明确，既往研究表明可能与癌细胞机械性阻塞导致淋巴液回流障碍有关[2]。临床上多采用单纯抽放水或利尿，治疗效果不甚理想。近年来腹腔热灌注化疗（HIPEC）逐渐成为治疗恶性腹水主要方法之一，其临床优势在于能够广泛地清扫种植在浆膜上的转移癌细胞，消除引发癌性积液的病灶，对于促使浆膜的修复具有积极的作用[3-4]。……