Kolschmann S, Ballin A, Juergens U-R, Rohde G, Gessner C, Hammerschmidt S, Wirtz H, Gillissen A
Robert Koch-Klinik, Klinikum St. Georg Leipzig.
Pneumologie. 2006 Feb;60(2):89-95. doi: 10.1055/s-2005-919139.
Pleural effusions associated with malignancy--either malignant or paramalignant diseases--were found in ca. 20% of these patients. Large pleural effusions cause mainly dyspnoea but also cough and chest pain. The presence and degree of dyspnoea depend on the size of the effusion and the patient's underlying pulmonary function. In acute cases and large effusions immediate chest drainage is indicated in symptomatic patients, followed by the treatment of the underlying disease, e. g. chemotherapy. The most effective therapy for controlling reiterated malignant pleural effusions is the thoracoscopic talc poudrage (2.5-10 g) which has been shown to have a success rate of > 90%. Talc induces a broad inflammatory reaction involving mesothelial cells of the pleura, coagulation parameters, fibroblast proliferation eventually leading to symphysis of the pleura. This procedure is reserved for patients who are in good general conditions, who are expected to have a reasonably long survival, and who failed chemical pleurodesis. A good predictor for longer survival time is a Karnofsky Performance Scale > or = 40 indicating a survival time > 30 days, which therefore should be considered prior to the procedure. The adult respiratory distress syndrome (ARDS) is the most important complication initially observed in the US in up to 9% of all cases. ARDS incidence was strongly related to high number (50%) of small talc particles < 15 microm. In summary, talc poudrage or slurry (talc particle size > 10 microm) in malignant pleura effusions is a safe and effective method to induce pleura symphysis. Complaints and complications such as chest pain, transient fever, and empyema are rare or very are which are almost exclusively related to the therapeutic procedure itself.
在这些患者中，约20%发现有与恶性肿瘤相关的胸腔积液，包括恶性或准恶性疾病。大量胸腔积液主要导致呼吸困难，还可引起咳嗽和胸痛。呼吸困难的出现及程度取决于积液量和患者潜在的肺功能。在急性病例和大量积液时，有症状的患者应立即进行胸腔引流，随后治疗基础疾病，如化疗。控制复发性恶性胸腔积液最有效的治疗方法是胸腔镜滑石粉喷洒术（2.5 - 10克），其成功率已被证明超过90%。滑石粉会引发广泛的炎症反应，涉及胸膜间皮细胞、凝血参数、成纤维细胞增殖，最终导致胸膜粘连。该手术适用于一般状况良好、预期生存期合理且化学性胸膜固定术失败的患者。卡氏功能状态评分≥40表明生存期>30天，是生存期较长的良好预测指标，因此在手术前应予以考虑。成人呼吸窘迫综合征（ARDS）是最初在美国观察到的最重要并发症，在所有病例中发生率高达9%。ARDS的发生率与大量（50%）直径<15微米的小滑石颗粒密切相关。总之，在恶性胸腔积液中使用滑石粉喷洒术或滑石粉浆（滑石颗粒大小>10微米）是诱导胸膜粘连的一种安全有效的方法。胸痛、短暂发热和脓胸等主诉及并发症很少见或非常罕见，且几乎都仅与治疗操作本身有关。
