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目的 评价热疗肺癌癌性胸水的综合疗效，探讨肿瘤热疗的机制。 方法 采用４３±０．５℃温盐水胸腔循环灌注６０ ｍ ｉｎ，治疗３０ 例肺癌癌性胸水患者，随访观察对胸水的疗效、肺原发病灶变化、生活质量以及生存期，评价其临床综合疗效，同时利用光镜、电镜、末端脱氧核苷酰转移酶原位标记（ＴＵＮＥＬ）等技术，比较了热疗前后胸膜转移癌细胞的形态学和生化学改变。 结果 全组均只经一次热疗，胸水控制有效率达１００％ （ＣＲ９６．７％ ＋ ＰＲ３．３％ ），仅１ 例于热疗后１ 年胸水复发，余２９ 例分别随访２～３１ 个月无胸水复发。１３ 例热疗后复查ＣＴ，发现肺部原发灶缩小者５ 例。无手术死亡及并发症。全组１ 年存活率达８０．０％ ，３ 例分别达２９，２４，３１ 个月。２８例热疗后生活质量明显提高。光镜、电镜见胸膜转移癌细胞胞核固缩、碎裂和凋亡小体，ＴＵＮＥＬ见带亮黄色荧光的凋亡阳性细胞。 结论 温盐水胸腔循环灌注是肺癌癌性胸水安全、有效的新疗法；凋亡介导的肿瘤细胞热杀伤作用是肿瘤热疗的独特机制。
Objective To evaluate the comprehensive efficacy of hyperthermia in the treatment of lung cancer with pleural effusion and explore the mechanism of hyperthermia. Methods A total of 30 cases of lung cancer with pleural effusion were treated with circulating saline at 43±0.5°C for 60 min. Follow-up observations of the efficacy of pleural effusion, primary lung lesion changes, quality of life, and survival period were performed to evaluate its clinical efficacy. At the same time, light microscopy, electron microscopy, terminal deoxynucleotidyl transferase in situ labeling (TUNEL) and other techniques were used to compare the morphological and biochemical changes of pleural metastatic cancer cells before and after hyperthermia. Results The whole group was treated with only one hyperthermia. The effective rate of pleural effusion control was 100% (CR96.7% + PR3.3%). Only 1 case had recurrence of pleural effusion 1 year after hyperthermia. The remaining 29 cases were followed up for 2 to 31 cases. No recurrence of pleural effusion. After 13 cases of hyperthermia were examined with CT, 5 cases of primary lung tumors were found to be reduced. No operative death and complications. The 1-year survival rate of the whole group was 80.0%, and 3 cases were 29, 24, and 31 months respectively. After 28 cases of hyperthermia, the quality of life improved significantly. Light microscopy and electron microscopy showed pleural metastasis of nucleus pyknosis, fragmentation and apoptotic bodies, and TUNEL showed apoptotic positive cells with bright yellow fluorescence. Conclusion Warm and saline saline thoracic cavity perfusion is a safe and effective new therapy for lung cancer pleural effusion. Apoptosis-mediated tumor cell heat killing is the unique mechanism of tumor hyperthermia.