| The high incidence and mortality rate of lung cancer is predominant among all the malignant tumors causing seriously harm to the health and life of human beings.As is well-known,the major reason of lung cancer is involved in smoking,genetic,occupation exposure,radiation,organic chemical pollution and bad living habits.With the aggravation of air pollution,the incidence of lung cancer in China increases year by year,which has becomed most prevalent cause of death.The incidence of tumor and death analysis report in 2010 pointed out that the incidence rate of lung cancer was the highest in China(46.08/100,000),and about 610,000 of new cases.Its mortality rate was also the highest,accounting for 24.87% of all malignant tumors.In addition,the mortality of lung cancer was also the highest,accounting for 24.87% of all malignancies.The incidence and mortality increase with age.Generally speaking,the incidence of lung cancer increases significantly above 40 years old.The peak age of its incidence rate and mortality rate is normally 75,then the curve turns downward.Malignant pleural effusion is one of the most complication,and the reasons include lung cancer(37%),breast cancer(25%),lymphoid tissue malignant tumor(10%),ovarian malignant tumors(5%),gastric cancer(2%),and others(13%)or metastatic lesions(7%).The non-small cell lung cancer accounts for about80%,and the difficulty of early diagnosis in clinical work is huge,so more than 70% of the patients under the definite diagnosis have entered the middle or even terminal stage.MPE is caused by malignant pleural metastasis and is a common complication among advanced lung cancer.Its incidence rate could reach sixty percent,and symptom gradually worsen.MTE prognosis is very bad.From definite diagnosis,the median survival period of lung cancer MPEis about 3 months to one year,which is closely related to the pathological types of primary tumor and TNM staging.Up till now,no clear mechanism is found in the world.In recent years,medical workers have furthered their research on the generation mechanism of MPE and its causes,and have been continuously updating and improving their guidance for clinical treatment.Today,many reports cover different medicines of various curative effects for the treatment of malignant pleural effusion,but after treatment the control rate of malignant pleural effusion is mostly about 50%-80%.In daily clinical work,there are many optional treatments and methods of MPE,including central venous catheter closed drainage,medicine of intrapleural injection,which has become the main treatment for malignant water.But the medicines for intrapleural injection are different,and their curative effects varies greatly.So how to find a safe and economic medicine of good effect is one of the difficulty.Recently,paclitaxel liposome is gradually applied in clinical treatment.Because of its use of nanotechnology and targeting characteristic,it can pass through tumor angiogenesis,acting on the tumor cells and killing them.The clinical application of paclitaxel liposome may be one of the most effective medicines to improve the curative effect in the treatment of malignant pleural effusion.Objective: Apply local injection of paclitaxel liposome for the treatment of malignant pleural effusion caused by non-small lung cancer by placing a central venous catheter through the chest,and observe the short-term efficacy and the adverse reaction.Method: Case source: approved by hebei chest hospital research ethics committee,collecting 40 cases of patients as MPE in histopathology in Hebei Chest Hospital from October 2015 to December 2016.1.MPE was diagnosed in histological or cytology.2whose KPS score was no less than 70 points or ECOG score was less than 1 points before treatment and whose chest X-ray or ultrasound confirmed the presence of a medium or large number of pleural effusion,who had not received intrathoracic injection in a month and whose KPS score was more than 70 points,whose expected survival time was noless than 3 months with more than 1 month of clinical follow-up.The relevant inspection and examination before the patients received thoracic perfusion confirming that no drug injection taboo existed.And the MPE patients had signed the informed consent as the object of study.Divided them into 2groups randomly according to pathological types(29 cases of adenocarcinoma,11 cases of squamous cell carcinoma): treatment group(20cases)and control group(20 cases).Applying pleural placement of central venous catheter drainage and treatment group were given paclitaxel liposome45mg/m2 and drug desensitization therapy 30 minutes before treatment,and control group were given Cisplatin Injection 45mg/m2.Comparing the patients’ effective rate,improvement rate of life quality and adverse reaction rate one month after the treatment,the difference was used by statistic method.Result: The effective rate of treatment group(6 cases of complete remission and 10 cases of partial remission)is 80.0%,which is significantly higher than that in control group(45.0%)(3 cases of complete remission and 6cases)(P<0.05).The improvement rate of KPS score is 80.0% in treatment group and 50.0% in control group.Both have improved and obvious difference is found(P< 0.05).Patients in both groups have fever,chest pain,gastrointestinal reaction and mild bone marrow suppression,etc.The fever rate and chest pain rate is 30.0% and 15.0% in treatment group and 35.0% and25.0% in the control.No significant difference is found(P>0.05);the gastrointestinal irritation accounting for 25.0% and bone marrow suppression accounting for 15.0% in treatment group,the rate of gastrointestinal irritation reaction is 60.0% in control group,while white blood cell and platelet reduction accounts for 45.0%.The difference is significant(P<0.05).Conclusion:1 Intrapleural injection of paclitaxel liposome is an effective and highly safe method of treatment of malignant pleural effusion,which can effectively control MPE.The main adverse reactions are gastrointestinal reaction,Bone marrow suppression and chest pain with mild adverse reactions and goodeffect.2 Contrast the life quality of both groups of patients before and after the treatment.The KPS score improvement rate in treatment group is significantly better than that in the control(80.0% vs 50.0%)(P<0.05). |
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