可植入式胸腔港在胸腔灌注治疗中的应用

发布时间：2018-01-19 00:00

本文关键词： 胸腔积液港中心静脉管灌注化疗胸膜固定术顺铂　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:恶性胸腔积液是指由肺恶性肿瘤或其他部位的恶性肿瘤侵及胸膜或由胸膜原发性肿瘤所导致的胸腔积液。对于有症状的患者,现有的治疗手段中主要采用的是胸膜固定术,通过胸管或胸腔镜的方式,排出积液、灌注各种硬化剂和化疗药。但是,对于肺复张差,没有很好的发生胸膜固定的患者来说,下一步采用何种方法治疗,仍然有待研讨。近几年,有少数国外的学者开始将“皮下植入式胸腔港”用于胸腔积液的治疗,包括法国、日本、德国、瑞士、比利时等,均取得不同的经验。本次研究是通过对新西兰白兔进行皮下植入式胸腔港手术,进行灌注治疗。观察白兔在接受此装置植入与中心静脉管植入的区别,以及药物注射后,胸腔内及全身的反应情况。进一步对此装置用于恶性胸腔积液的治疗效果及风险进行评估。方法:选用河北医科大学新西兰白兔72只、体重2kg±1kg、全部为雄性大白兔。此项研究中的胸腔港是从省四院乳腺外科的患者体内取出的静脉港(构造、原理与国外所用胸腔港基本相同)。中心静脉管使用美国ARROW牌单腔中心静脉导管。导管需经生理盐水冲洗,环氧乙烷消毒。将72只白兔随机分为三组,每组24只。A组白兔胸腔留置植入式胸腔港,灌注生理盐水。B组胸腔留置中心静脉管,灌注生理盐水。C组胸腔留置植入式胸腔港,灌注顺铂。三个月试验结束,在A组白兔耳中抽取动脉血,化验血气分析,对比与术前指标变化情况。并检查各组白兔的机体健康情况,确保实验有效性。本实验按照实验动物伦理要求和处死原则处死实验白兔,最后取埋港侧的港周软组织、管周软组织、壁层胸膜、膈肌面组织、及肺组织做病理检查。结果:1 A组(胸腔港-盐水组)试验前后比较经比较,试验前后血气化验结果无明显变化,证实此可植入式胸腔港对肺功能影响极小.从白兔的胸部CT检查结果看,并没有观测到肺不张、肺炎的发生,而且在处死后取同侧肺组织病理化验示:肺泡结构清晰,大致正常。说明此装置植入胸腔后对肺脏无明显的刺激、影响。2 A组(胸腔港-盐水组)与B组(中心静脉管-盐水组)比较2.1感染率比较至试验结束,解剖白兔A组中有1只切口红肿、余23只无感染。B组中有12只发生切口的红肿,2只发生切口化脓、1只发生脓胸而死亡(术后50天时)、余9只未感染。经Wilcoxon秩和检验,P0.001.说明在灌注生理盐水的情况下,应用胸腔港与应用中心静脉管的感染程度有统计学差异,即应用胸腔港的感染程度明显低于中心静脉管。2.2通畅性比较A组和B组至实验结束时均通畅性良好,注入药物顺利,无一堵管发生。说明在通畅性方面,胸腔港与中心静脉管无明显差别。2.3植入物稳定性的比较A组24只白兔中管及港的位置固定良好。B组(中心静脉管-盐水组)有一只白兔因搔抓,造成中心静脉的破损。说明胸腔港植入皮下后稳定性较强,不易移位或破损;而中心静脉管因有裸露部分,可因牵拉、挤压、锐物接触等原因而造成管的脱落或损伤。3 A组(胸腔港-盐水组)与C组(胸腔港-顺铂组)比较胸膜粘连度结果A组(胸腔港-盐水组)中21只未见明显胸膜粘连,肺表面组织正常;3只有一条粘连带,多位于管入胸腔处。C组(胸腔港-顺铂组)24只已发生明显的粘连,主要粘连位于心隔角、和肋膈角附近,其中1只有三到五条粘连带。21只有五条以上粘连带。2只整个胸腔广泛粘连。经比较C组(胸腔港-顺铂组)粘连程度明显大于A组(胸腔港-盐水组),再次验证了顺铂用于胸腔灌注化疗时,顺铂刺激胸膜可发生无菌性炎症,并产生粘连效果。而盐水组的胸管周围无明显粘连,说明了粘连是化疗药物产生的,而与此植入式胸腔港无关。结论:1皮下植入式胸腔港作为胸腔引流装置感染率低于中心静脉管。2皮下植入式胸腔港植入胸腔后本身不产生胸膜粘连作用。3皮下植入式胸腔港植入后对肺功能无明显影响、无明显全身炎症反应。4皮下植入式胸腔港的操作是安全的、微创的。5皮下植入式胸腔港的使用效果是肯定的,可以用于长期的引流及给药。6顺铂用于灌注化疗可产生粘连效果。
[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.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R655

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