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目的评价胸腔镜术在综合治疗肺癌伴恶性胸腔积液中的临床价值和手术适应证。方法53例非小细胞肺癌并恶性胸腔积液患者被单盲随机分为胸腔镜手术组(胸腔镜组)和闭式引流术组(引流组),两组均应用泰素联合伯尔定方案行全身化疗4个疗程观察,以胸腔积液疗效,生存质量和生存率为评价指标。结果胸腔镜组胸液控制有效率为92.3%,完全缓解率为88.5%;引流组有效率为59.3%,完全缓解率为44.4%,差异有统计学意义(P<0.05);每组治疗前后KPS评分差值的中位数在胸腔镜组为30分,均数为33.5±11.3,引流组中位数为20分,均数为24.07±10.5,两组差异有统计学意义(P<0.05)。随访到2005年8月,随访率100%,胸腔镜组中位生存时间为20个月,1年生存率65.4%,2年生存率38.5%,3年生存率22.4%;引流组中位生存时间为15个月,1年生存率59.3%,2年生存率25.9%,3年生存率14.8%,两组差异无统计学意义(P>0.05)。结论在非小细胞肺癌并恶性胸腔积液的综合治疗中,胸腔镜胸膜剥除术在有效控制恶性胸腔积液、提高患者生存质量方面明显优于胸腔闭式引流术,但在生存率方面无明显差异。除Ⅳ级胸腔积液外,Ⅰ、Ⅱ、Ⅲ级均为手术适应证。
Objective To evaluate the clinical value and surgical indications of thoracoscope in the treatment of lung cancer with malignant pleural effusion. Methods Fifty-three patients with non-small cell lung cancer and malignant pleural effusion were randomly divided into thoracoscopic surgery group (thoracoscope group) and closed drainage group (drainage group). Both groups were treated with combination of quetiapine and quetiapine Four courses of systemic chemotherapy were observed, with pleural effusion efficacy, quality of life and survival rate as the evaluation index. Results The effective rate of pleural fluid control in thoracoscopic group was 92.3% and the complete remission rate was 88.5%. The effective rate of drainage group was 59.3% and the complete remission rate was 44.4%, the difference was statistically significant (P <0.05) The median KPS score difference was 30 points in the thoracoscopic group, the average was 33.5 ± 11.3, the median drainage group was 20 points, the mean was 24.07 ± 10.5, the difference between the two groups was statistically significant (P <0.05 ). Follow-up to August 2005, the follow-up rate was 100%. The median survival time in thoracoscopic group was 20 months. The 1-year survival rate was 65.4%, the 2-year survival rate was 38.5%, and the 3-year survival rate was 22.4% The time was 15 months, the 1-year survival rate was 59.3%, the 2-year survival rate was 25.9%, and the 3-year survival rate was 14.8%. There was no significant difference between the two groups (P> 0.05). Conclusion In the comprehensive treatment of non-small cell lung cancer with malignant pleural effusion, thoracoscopic pleural ablation is superior to thoracic closed drainage in effectively controlling malignant pleural effusion and improving patient’s quality of life. However, in terms of survival rate Significant differences. In addition to grade IV pleural effusion, Ⅰ, Ⅱ, Ⅲ are surgical indications.