Porcel José Manuel, Salud Antonieta, Nabal Maria, Vives Manuel, Esquerda Aureli, Rodríguez-Panadero Francisco
Department of Internal Medicine, Arnau de Vilanova University Hospital, Lleida, Spain.
Support Care Cancer. 2006 May;14(5):475-8. doi: 10.1007/s00520-005-0001-x. Epub 2006 Jan 10.
The goal of the study was to evaluate the safety and efficacy of bedside pleurodesis with doxycycline using a short-term indwelling chest catheter for the palliative treatment of malignant effusions.
A prospective study of 36 rapid pleurodesis procedures in 34 patients with malignant pleural effusions was conducted over a 5-year period in a university hospital. A 12F chest catheter placement was facilitated utilizing the Seldinger percutaneous entry technique. Patients received 500 mg of intrapleural doxycycline combined in half of the cases with mepivacaine. We assessed success or failure of pleurodesis in addition to the frequency of complications and survival.
Chest tubes were removed within 24 h in 69% and within 48 h in 94% of the patients. Complete success of pleurodesis was achieved in 17 (55%), partial success in eight (26%), and failure in six (19%) out of 31 evaluative procedures. Thus, the overall success rate of pleurodesis was 81%. Toxicity was mild and included pain (36%), fever (8%), and pneumothorax (6%). The median survival was 105 days. There was no relationship between instillation of intrapleural anesthetics and development of pain.
Rapid pleurodesis with doxycycline, which can be accomplished within 24 to 48 h, is a valid option for the symptomatic treatment of malignant effusions. This technique can be used as a first-line procedure in the majority of cases, particularly if thoracoscopic facilities are not available.
本研究的目的是评估使用短期留置胸腔导管进行多西环素床旁胸膜固定术对恶性胸腔积液进行姑息治疗的安全性和有效性。
在一所大学医院进行了一项为期5年的前瞻性研究，对34例恶性胸腔积液患者进行了36次快速胸膜固定术。采用Seldinger经皮穿刺技术放置12F胸腔导管。患者接受500mg胸腔内多西环素治疗，半数病例联合甲哌卡因。除了并发症发生率和生存率外，我们还评估了胸膜固定术的成功或失败情况。
69%的患者在24小时内拔除胸腔引流管，94%的患者在48小时内拔除。在31例评估手术中，胸膜固定术完全成功17例（55%），部分成功8例（26%），失败6例（19%）。因此，胸膜固定术的总体成功率为81%。毒性反应较轻，包括疼痛（36%）、发热（8%）和气胸（6%）。中位生存期为105天。胸腔内注射麻醉剂与疼痛的发生之间没有关系。
多西环素快速胸膜固定术可在24至48小时内完成，是治疗恶性胸腔积液症状的有效选择。在大多数情况下，特别是在没有胸腔镜设备的情况下，该技术可作为一线治疗方法。
