Brega-Massone P P, Conti B, Magnani B, Ferro F, Lequaglie C
Oncologic Thoracic Surgery, National Cancer Institute, Milan, Italy.
Thorac Cardiovasc Surg. 2004 Aug;52(4):191-5. doi: 10.1055/s-2004-820869.
We evaluated the effectiveness of VATS in the diagnosis and palliative treatment of recurrent neoplastic pleural effusions.
From 1987 to 2001, we performed 325 VATS chemical pleurodesis for malignant pleural effusions. We used talc in 253 subjects (78 %) and alcohol in 72 (22 %) as the sclerosant agent. In 226 patients (68 %) we performed biopsies because the histology was unknown.
Mean operating time was 33.38 +/- 9.77 minutes (median: 32; range: 19 - 58), and the mean duration of chest intubation was 3.78 +/- 1.33 days (median: 4; range 2 - 8). Complications occurred in 2 % of patients. Thirty-day mortality was 2 %. Mean postoperative in hospital stay was 5.53 +/- 1.90 days (median 6; range: 2 - 11). We obtained 264 (81 %) therapeutic successes (no effusion recurrence within 4 months), and 55 relapses of which 32 had talc insufflation (13 % of talc group) and 23 alcohol instillation (32 % of alcohol group).
VATS chemical pleurodesis is a safe, useful, versatile procedure for oncological pleural effusion management. The use of talc rather than alcohol significantly increased the therapeutic success rate. VATS should be considered the treatment of choice in patients with advanced neoplasm to obtain good palliation and a better quality of life.
我们评估了电视辅助胸腔镜手术（VATS）在复发性肿瘤性胸腔积液诊断及姑息治疗中的有效性。
1987年至2001年期间，我们对恶性胸腔积液患者实施了325例VATS化学性胸膜固定术。253例（78%）患者使用滑石粉，72例（22%）患者使用酒精作为硬化剂。226例患者（68%）因组织学情况不明而进行了活检。
平均手术时间为33.38±9.77分钟（中位数：32；范围：19 - 58），平均胸腔插管时间为3.78±1.33天（中位数：4；范围2 - 8）。2%的患者出现并发症。30天死亡率为2%。术后平均住院时间为5.53±1.90天（中位数6；范围：2 - 11）。我们获得了264例（81%）治疗成功病例（4个月内无积液复发），55例复发，其中32例为滑石粉吹入（滑石粉组的13%），23例为酒精注入（酒精组的32%）。
VATS化学性胸膜固定术是一种安全、有用且多功能的肿瘤性胸腔积液治疗方法。使用滑石粉而非酒精可显著提高治疗成功率。对于晚期肿瘤患者，应将VATS视为获得良好姑息治疗及改善生活质量的首选治疗方法。
