Pollak J S, Burdge C M, Rosenblatt M, Houston J P, Hwu W J, Murren J
Department of Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8042, USA.
J Vasc Interv Radiol. 2001 Feb;12(2):201-8. doi: 10.1016/s1051-0443(07)61826-0.
To assess the effectiveness of tunneled pleural catheters (TPCs) in the treatment of malignant pleural effusions (MPEs).
Twenty-eight patients with symptomatic MPEs had 31 hemithoraces treated with TPCs placed under image guidance. Chemical sclerotherapy had failed in two patients and two had symptomatic locules. Drainage was accomplished by intermittent connection to vacuum bottles. Pleurodesis was considered achieved when three consecutive outputs were scant and imaging showed no residual fluid.
All catheters were successfully placed. Dyspnea improved in 94% (29 of 31 hemithoraces) at 48 hours and 91% (20 of 22 patients) at 30 days. Control of the MPE was achieved in 90% of hemithoraces (28/31), although five required ancillary procedures. Pleurodesis occurred in 42% (13 of 31) of hemithoraces, including both that underwent an earlier attempt at chemical sclerotherapy and one treated locule. Continued drainage without pleurodesis controlled the effusion in 48% (15 of 31). In only 7% was hospital time necessary for care related to the TPC. Early, transient catheter-related pain was common, but only three complications (in two patients) occurred. Neither of these altered patient care.
Regardless of whether pleurodesis is achieved, TPCs provide effective long-term outpatient palliation of MPEs.
评估隧道式胸腔导管（TPC）治疗恶性胸腔积液（MPE）的有效性。
28例有症状的MPE患者的31个半侧胸腔在影像引导下置入TPC进行治疗。2例患者化学硬化治疗失败，2例有症状性分隔腔。通过间歇性连接真空瓶进行引流。当连续三次引流量很少且影像学显示无残留液体时，认为胸膜固定术成功。
所有导管均成功置入。48小时时94%（31个半侧胸腔中的29个）的呼吸困难得到改善，30天时91%（22例患者中的20例）得到改善。90%的半侧胸腔（28/31）实现了MPE的控制，尽管有5例需要辅助程序。42%（31个半侧胸腔中的13个）的半侧胸腔发生了胸膜固定术，包括之前尝试过化学硬化治疗的以及1个治疗过的分隔腔。持续引流但未行胸膜固定术控制了48%（31个中的15个）的胸腔积液。仅7%的患者因与TPC相关的护理需要住院治疗。早期短暂的导管相关疼痛很常见，但仅发生了3例并发症（2例患者）。这些均未改变患者的治疗。
无论是否实现胸膜固定术，TPC均可为MPE提供有效的长期门诊姑息治疗。
