本文關(guān)鍵詞： 胸腔積液 港 中心靜脈管 灌注化療 胸膜固定術(shù) 順鉑　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:惡性胸腔積液是指由肺惡性腫瘤或其他部位的惡性腫瘤侵及胸膜或由胸膜原發(fā)性腫瘤所導(dǎo)致的胸腔積液。對于有癥狀的患者,現(xiàn)有的治療手段中主要采用的是胸膜固定術(shù),通過胸管或胸腔鏡的方式,排出積液、灌注各種硬化劑和化療藥。但是,對于肺復(fù)張差,沒有很好的發(fā)生胸膜固定的患者來說,下一步采用何種方法治療,仍然有待研討。近幾年,有少數(shù)國外的學(xué)者開始將“皮下植入式胸腔港”用于胸腔積液的治療,包括法國、日本、德國、瑞士、比利時等,均取得不同的經(jīng)驗。本次研究是通過對新西蘭白兔進行皮下植入式胸腔港手術(shù),進行灌注治療。觀察白兔在接受此裝置植入與中心靜脈管植入的區(qū)別,以及藥物注射后,胸腔內(nèi)及全身的反應(yīng)情況。進一步對此裝置用于惡性胸腔積液的治療效果及風(fēng)險進行評估。方法:選用河北醫(yī)科大學(xué)新西蘭白兔72只、體重2kg±1kg、全部為雄性大白兔。此項研究中的胸腔港是從省四院乳腺外科的患者體內(nèi)取出的靜脈港(構(gòu)造、原理與國外所用胸腔港基本相同)。中心靜脈管使用美國ARROW牌單腔中心靜脈導(dǎo)管。導(dǎo)管需經(jīng)生理鹽水沖洗,環(huán)氧乙烷消毒。將72只白兔隨機分為三組,每組24只。A組白兔胸腔留置植入式胸腔港,灌注生理鹽水。B組胸腔留置中心靜脈管,灌注生理鹽水。C組胸腔留置植入式胸腔港,灌注順鉑。三個月試驗結(jié)束,在A組白兔耳中抽取動脈血,化驗血氣分析,對比與術(shù)前指標(biāo)變化情況。并檢查各組白兔的機體健康情況,確保實驗有效性。本實驗按照實驗動物倫理要求和處死原則處死實驗白兔,最后取埋港側(cè)的港周軟組織、管周軟組織、壁層胸膜、膈肌面組織、及肺組織做病理檢查。結(jié)果:1 A組(胸腔港-鹽水組)試驗前后比較經(jīng)比較,試驗前后血氣化驗結(jié)果無明顯變化,證實此可植入式胸腔港對肺功能影響極小.從白兔的胸部CT檢查結(jié)果看,并沒有觀測到肺不張、肺炎的發(fā)生,而且在處死后取同側(cè)肺組織病理化驗示:肺泡結(jié)構(gòu)清晰,大致正常。說明此裝置植入胸腔后對肺臟無明顯的刺激、影響。2 A組(胸腔港-鹽水組)與B組(中心靜脈管-鹽水組)比較2.1感染率比較至試驗結(jié)束,解剖白兔A組中有1只切口紅腫、余23只無感染。B組中有12只發(fā)生切口的紅腫,2只發(fā)生切口化膿、1只發(fā)生膿胸而死亡(術(shù)后50天時)、余9只未感染。經(jīng)Wilcoxon秩和檢驗,P0.001.說明在灌注生理鹽水的情況下,應(yīng)用胸腔港與應(yīng)用中心靜脈管的感染程度有統(tǒng)計學(xué)差異,即應(yīng)用胸腔港的感染程度明顯低于中心靜脈管。2.2通暢性比較A組和B組至實驗結(jié)束時均通暢性良好,注入藥物順利,無一堵管發(fā)生。說明在通暢性方面,胸腔港與中心靜脈管無明顯差別。2.3植入物穩(wěn)定性的比較A組24只白兔中管及港的位置固定良好。B組(中心靜脈管-鹽水組)有一只白兔因搔抓,造成中心靜脈的破損。說明胸腔港植入皮下后穩(wěn)定性較強,不易移位或破損;而中心靜脈管因有裸露部分,可因牽拉、擠壓、銳物接觸等原因而造成管的脫落或損傷。3 A組(胸腔港-鹽水組)與C組(胸腔港-順鉑組)比較胸膜粘連度結(jié)果A組(胸腔港-鹽水組)中21只未見明顯胸膜粘連,肺表面組織正常;3只有一條粘連帶,多位于管入胸腔處。C組(胸腔港-順鉑組)24只已發(fā)生明顯的粘連,主要粘連位于心隔角、和肋膈角附近,其中1只有三到五條粘連帶。21只有五條以上粘連帶。2只整個胸腔廣泛粘連。經(jīng)比較C組(胸腔港-順鉑組)粘連程度明顯大于A組(胸腔港-鹽水組),再次驗證了順鉑用于胸腔灌注化療時,順鉑刺激胸膜可發(fā)生無菌性炎癥,并產(chǎn)生粘連效果。而鹽水組的胸管周圍無明顯粘連,說明了粘連是化療藥物產(chǎn)生的,而與此植入式胸腔港無關(guān)。結(jié)論:1皮下植入式胸腔港作為胸腔引流裝置感染率低于中心靜脈管。2皮下植入式胸腔港植入胸腔后本身不產(chǎn)生胸膜粘連作用。3皮下植入式胸腔港植入后對肺功能無明顯影響、無明顯全身炎癥反應(yīng)。4皮下植入式胸腔港的操作是安全的、微創(chuàng)的。5皮下植入式胸腔港的使用效果是肯定的,可以用于長期的引流及給藥。6順鉑用于灌注化療可產(chǎn)生粘連效果。
[Abstract]:Objective: malignant pleural effusion is caused by malignant lung tumors or other parts of the malignant tumors involving the pleura or the primary tumor of pleura and pleural effusion. For symptomatic patients, mainly by the existing treatment of pleurodesis, fluid discharge through the chest tube or thoracoscopic approach. Perfusion of hardener and chemotherapy. However, for the atelectasis, pleural fixation did not occur in patients with a good, the next step of the method by which the treatment remains to be research. In recent years, some foreign scholars began to "implanted pleural port for the treatment of pleural effusion, including France Japan, Germany, Switzerland, Belgium, etc., have different experiences. This research is carried out through the thoracic surgery on subcutaneously implanted port of New Zealand white rabbits were observed in rabbits received reperfusion therapy. The device implanted with center The difference between vein tube implantation, and after the drug injection reaction of intrathoracic and systemic. This device is used for further treatment and risk of malignant pleural effusion were evaluated. Methods: the Hebei Medical University 72 New Zealand white rabbits, weighing 2kg + 1kg, all male rabbits in this study. The chest is removed from Hong Kong fourth, breast surgery patients with venous port (structure, principle and used abroad in Hong Kong are basically the same. The pleural central venous tube) using the ARROW card single lumen central venous catheter. The catheter should be rinsed with normal saline, ethylene oxide sterilization. 72 rabbits were randomly divided into three groups, 24 rats in each group were.A pleural indwelling pleural implantable port, saline perfusion group.B pleural indwelling central venous perfusion tube, saline group.C pleural indwelling pleural implantable port, infusion of cisplatin. After three months of testing, in the A group of rabbit ears Arterial blood tests, blood gas analysis, compared with the preoperative indexes. And check the health condition of the body of each rabbit, to ensure the effectiveness of the experimental animal ethics. According to the experimental requirements and principles were then killed the rabbits, port of soft tissue around finally buried port side of the tube, soft tissues, parietal pleura. Diaphragmatic surface tissue and lung tissue pathological examination. Results: 1 A group (thoracic port - saline group) test comparison before and after the comparison test before and after the blood test results had no obvious change, confirmed that this can affect the implantable port on the pulmonary function of pleural is minimal. From the results of chest CT examination did not see the white rabbit, lung Zhang observed, pneumonia, and sacrificed in the ipsilateral lung tissue pathology showed alveolar structure clear, roughly normal. The device implanted in the chest of the lung had no obvious stimulation effect of.2 A group (thoracic port - saline group and B group (in) Heart vein - saline group) to compare 2.1 infection rate compared to the end of the experiment, the anatomy of rabbit in group A was 1 more than 23 incision swelling, no infection occurred only in 12 of.B group incision swelling, 2 wound fester, 1 had died of empyema (50 days after transplantation), more than 9. Not infected by Wilcoxon rank sum test, P0.001. in saline perfusion conditions, there were significant differences in the degree of infection by thoracic port and the application of central venous tube, namely the degree of infection was significantly lower than that in Hong Kong using pleural central venous tube patency over A.2.2 group and B group to experiment were patency well, no drug injection well plugging. In patency, pleural port and A vein tube center is no significant difference in.2.3 implant stability group 24 rabbits in the pipe and the fixed position of Hong Kong good.B (central venous tube - saline group) a rabbit from scratch Catch the damage caused by central venous. After subcutaneous implantation of pleural port has strong stability, not easy to shift or damage; central venous tube due to the exposed part can be squeezed by pulling, the sharp contact caused by tube falling off or damage.3 A group (Hong Kong - pleural saline group) and group C (Hong Kong - pleural pleural adhesion degree compared cisplatin group) results in the A group (pleural port group) in 21 without obvious pleural adhesions, 3 normal lung tissue surface; only a stick into the chest tube joint, located in.C group (thoracic port - cisplatin group) 24 has obvious adhesion the main adhesion in the heart septal angle, and near the costophrenic angle, 1 of which only three to five strips of adhesive joint.21 only more than five.2 only the pleural adhesions. After extensive adhesion between C group (thoracic port - cisplatin group) the level of adhesion was significantly greater than group A (saline group, pleural port) is verified again cisplatin for pleural perfusion chemotherapy, Cisplatin stimulated pleura aseptic inflammation, and adhesion effect. But no obvious adhesion of saline group around the chest tube, the adhesion is caused by chemotherapy drugs, and has nothing to do with the implantable pleural. Conclusion: 1 subcutaneous implantable port port as pleural drainage device for thoracic cavity infection rate is lower than the central venous tube.2 implanted pleural port implanted in the chest itself does not produce pleural adhesions.3 subcutaneously implanted pleural port after implantation on pulmonary function had no significant effect, no obvious systemic inflammatory response.4 subcutaneously implanted pleural port operation is safe, minimally invasive.5 subcutaneous implantable pleural port use effect is in the affirmative, can be used for drainage and administration of cisplatin chemotherapy for.6 can produce adhesion effect for a long time.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R655

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本文編號：1441712