Ambăruş V, Cosovanu A, Ungureanu G, Hanganu E, Ionescu S, Grozdan R
Clinica a III-a medicală, Universitatea de Medicină şi Farmacie Iaşi.
Rev Med Chir Soc Med Nat Iasi. 1992 Jul-Dec;96(3-4):157-62.
During a 10-year interval (1981-1991), at the IIIrd Medical Clinic of Iaşi 960 cases with pleural effusion, of which 768 (80%) non-recurrent and 192 (20%) recurrent, were diagnosed. The etiology in the latter cases was malignant (40%) and non-malignant (60%). Proper treatment methods for limiting or suppressing the recurrent pleurisies proved to be imperative. Thoracocenteses cause protein and electrolyte depletion which aggravate the general state and hasten the unfavourable evolution of the etiological affection. This is the reason why besides the general etiopathogenic treatment, a local pathogenic treatment (cytostatic, anti-inflammatory) and especially pleurodesis are compulsory. The intrapleural administration of cortisone is efficient in the case of recurrent autoimmune pleural effusions but is worthless in the malignant ones. In the latter situation, the intrapleural cytostatic treatment should be first attempted and, in case of failure, the development of pleural symphysis by external radiotherapy or injecting talc into the pleural space should be made. In the terminal stage of cardiac insufficiency or liver cirrhosis with recurrent pleural effusion, the pleurosymphysation is not indicated; a sever edematous-ascitic attack may occur or become aggravated by the pleural irritative process due to this method.
在10年期间（1981 - 1991年），雅西第三医疗诊所诊断出960例胸腔积液病例，其中768例（80%）为非复发性，192例（20%）为复发性。后一组病例的病因是恶性的（40%）和非恶性的（60%）。事实证明，采取适当的治疗方法来限制或抑制复发性胸膜炎势在必行。胸腔穿刺会导致蛋白质和电解质消耗，从而加重全身状况并加速病因性疾病的不利进展。这就是为什么除了一般的病因治疗外，局部病因治疗（细胞抑制剂、抗炎），尤其是胸膜固定术是必不可少的。胸腔内注射可的松对复发性自身免疫性胸腔积液有效，但对恶性胸腔积液无效。在后一种情况下，应首先尝试胸腔内细胞抑制治疗，若治疗失败，则应通过外部放疗或向胸腔内注入滑石粉来促使胸膜粘连。在心力衰竭或肝硬化伴有复发性胸腔积液的终末期，不建议进行胸膜粘连术；采用这种方法可能会引发严重的水肿 - 腹水发作，或因胸膜刺激过程而加重病情。
