Martinoni Alessandro
Recenti Prog Med. 2006 Apr;97(4):206-10.
Pericardial effusion is a known complication of many advanced malignancies, with strong impact both on quality of life and prognosis. The initial and easier relief can be obtained through percutaneous pericardiocentesis, echo- or fluoro-guided. However, effusion recurrences can be observed in up to 40% of cases. Effective management can be obtained by more invasive approaches like percutaneous or surgical creation of pericardial windows but the more cost-effective procedure is pericardiocentesis followed by intrapericardial instillation of sclerosing or cytostatic agents like tetracyclines, bleomycin, cisplatin and thiotepa. No significant local or systemic side effects are reported, except for chest pain during tetracyclines instillation. No recurrences at 30 days are observed in 80%-90% of patients, according to different series and, particularly, to different malignancies. No evidence-based data are in fact available to assess the "gold standard" and the best therapeutical approach for the single patient.
心包积液是许多晚期恶性肿瘤的一种已知并发症，对生活质量和预后都有很大影响。最初且较为简便的缓解方法是通过超声或透视引导下的经皮心包穿刺术。然而，高达40%的病例可能会出现积液复发。更具侵入性的方法如经皮或手术创建心包开窗可实现有效治疗，但更具成本效益的方法是心包穿刺术，随后在心包内注入硬化剂或细胞抑制剂，如四环素、博来霉素、顺铂和噻替派。除了在注入四环素期间出现胸痛外，未报告有明显的局部或全身副作用。根据不同系列研究，特别是针对不同恶性肿瘤的研究，80%-90%的患者在30天内未出现复发。实际上，目前尚无基于证据的数据来评估针对单个患者的“金标准”和最佳治疗方法。
