Tucakovic M, Bascom R, Bascom P B
Pulmonary, Allergy and Critical Care Medicine, the Department of Medicine, Penn State College of Medicine, The Milton S. Hershey Medical Center, Hershey, PA, USA.
Best Pract Res Clin Obstet Gynaecol. 2001 Apr;15(2):291-304. doi: 10.1053/beog.2000.0169.
Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.
妇科恶性肿瘤对呼吸系统有直接和间接影响。恶性胸腔积液是一个不良预后因素：治疗选择包括反复胸腔穿刺术、化学性胸膜固定术、通过吸氧和使用吗啡缓解呼吸困难症状以及外部引流。实质转移通常为多灶性，对化疗有反应，肺转移瘤切除术的作用有限。肺肿瘤栓塞常与淋巴管癌病相关，在绒毛膜癌中最为常见。与癌症高凝状态相关的血栓栓塞性疾病采用抗凝治疗。当无法进行抗凝治疗或尽管进行了充分抗凝仍有栓子复发时，需放置下腔静脉滤器。姑息治疗在妇科恶性肿瘤的呼吸道症状治疗中起主要作用。可治疗的呼吸困难原因包括支气管痉挛、液体过载和分泌物潴留。阿片类药物可有效缓解与胸腔积液、转移和淋巴管肿瘤扩散相关的呼吸困难。非药物治疗包括节省能量、重新设计家居以及呼吸困难缓解策略，如缩唇呼吸、放松、吸氧、用风扇通风和关注精神痛苦。识别和治疗胃食管反流、鼻窦炎和哮喘可改善许多患者的咳嗽症状。胸壁疼痛可通过局部放疗、神经阻滞或全身镇痛来缓解。病例示例说明了处理生活质量问题的方法。
