体外循环全身热灌注治疗恶性肿瘤的疗效及安全性评估

1、体外循环全身热灌注治疗恶性肿瘤的疗效及安全性评估            侯凯生，金重华，高友福，陈雪良关键词：体外循环全身热灌注治疗           【摘要】  目的  评估体外循环全身热灌注（EWBH）治疗复发、转移性肿瘤的疗效及安全性，观察其对全身各主要组织器官的损伤情况。方法  监测60例2002年6月2004年6月EWBH联合化疗的各类复发、转移

2、性肿瘤病人术中各测温点的温度及相应的血液成分、肝、肾等脏器功能指标的变化，观察EWBH的安全性及对各组织器官的损伤；选择同期相同肿瘤类型及其化疗方案的病人45例作为对照组，比较EWBH组与对照组的疗效。结果  EWBH治疗复发、转移性肿瘤病人的有效率(CR+PR+SD)为72.6%，PD 为 27.4%，血液相关肿瘤指标下降率为72.6%，肿瘤疼痛缓解率70.2%，体重增加率50.0%，睡眠改善率56.7%，术后KPS评分提高66.1%。一年生存率51.2%，半年生存率80.4%，明显高于对照组(P0.05)。该疗法升控温平稳安全。结论  EWBH过程是平稳安全的，不会造成

3、患者重要组织器官的损害，对治疗肿瘤有其不可忽视的疗效。        【关键词】  体外循环全身热灌注治疗；化疗；恶性肿瘤；疗效；安全性        Assessment of the effects and clinical safety of the treatment of advanced malignant tumor with extracorporeal whole body hyperthermia    &

4、#160;          【Abstract】  Objective  To assay the primary effects and clinical safety of the treatment of advanced malignant tumor with extracorporeal whole body hyperthermia(EWBH)，and to evaluate the impairment of it to the vital organs and ti

5、ssues.Methods  60 patients of advanced malignant tumor were treated with EWBH and chemotherapy from June 2002 to June 2004， while the control group (n=45) with same spectrum and same stage of tumors were treated with similar chemotherapy alone. We assayed the primary effects of EWBH through com

6、paring with controls. The stability and safety of EWBH in monitoring and controlling the body temperature were evaluated by real-time temperature measurement as well as the impairments of vital organs and tissues， such as brain， liver， kidney and lung， were by examination functional index of body pe

7、ripheral blood.Results  (1) The effective rate (CR+PR+SD) of EWBH and chemotherapy was 72.6% on treating advanced malignant tumor， PD was 27.4%， the descent rate of index concerning tumor (as AFP， CER， CA199， CA242， CA125 and so on) was 72.6 %， the rate of pain relieve was 70.2%， the percentage

8、 of cases， whole body weight had increased post-EWBH after four weeks， reached 50.0%， and that of those appetite advanced was 76.5%， of those sleep improved was 56.7%. The indexes of Karnofsky was increased. 66.1%.51.2% patients alive were over one year and 80.4%over half one year. All of them are b

9、etter than controls (P0.05). (2)Although there are some impairment on function and tissues in the vital organ， the damage is venial and reversible. (3) The method of EWBH is steadily and safe on monitoring and controlling body temperature.Conclusion  EWBH can make some reversible impair to the

10、some vital organs and tissues， the whole procedure is steady and safe as one of hyper thermia therapy to the malignant tumor. EWBH can improve the patients  live quality and prolong their life.        【Key words】  extracorporeal；whole body hyperthermia；chemoth

11、erapy；malignant tumor；effect；safety        体外循环全身热灌注治疗(extracorporeal whole body hyperthermia，EWBH)是肿瘤全身热疗的一种方法，近年来在国内外越来越受到重视，并在临床上取得了良好的治疗效果1，2。我院采用美国FCM的TEMETTM1000型体外循环全身热灌注治疗系统，对各类复发、转移性肿瘤病人进行全身热疗联合化疗，并分析其疗效和安全性。        1

12、0; 资料与方法      1.1  一般资料  自2002年6月2004年6月，笔者对60例各类复发、转移性肿瘤患者进行EWBH共62例次，其中2例病人进行EWBH 2次，余均为1次。所有病人行EWBH的同时加用相应化疗药物。男39例，女21例；平均年龄43.6±1.4岁，其中年龄最大76岁，最小26岁。其中结直肠癌11例，肝癌10例，肺癌8例，胃癌5例，胰腺癌4例，上颌窦癌4例，乳腺癌3例，肾癌3例，骨肉瘤2例，恶性神经鞘膜瘤2例，胸腔恶性间皮瘤2例，卵巢癌1例，腹腔恶性间皮瘤1例，鼻咽癌1例，舌癌1例，左颚腺

13、样囊性癌1例，纵隔神经母细胞瘤1例。选择同期相同肿瘤类型及其化疗方案的患者45例作为对照组。        1.2  病例选择  EWBH治疗前对病人进行选择的标准如下：(1)有病理或细胞学证实的各类型恶性肿瘤，或已无手术机会、或术后复发、转移，或经过放疗、化疗无效者。(2)KPS评分60分。(3)能耐受全身麻醉。        1.3  治疗方法  全身麻醉下，采用美国FCM的TEMET1000型体外循环全身热灌注治疗系统。经双侧股静脉穿刺置管，连接替外循环治疗系统，通过由静脉至静脉，低流量，低压力的体外转流方式，治疗系统缓慢升高患者的血温，通过血液循环，血液灌注的作用，缓慢、均匀地升高全身体温，此为升