Arapis K, Caliandro R, Stern J-B, Girard P, Debrosse D, Gossot D
Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014, Paris, France.
Surg Endosc. 2006 Jun;20(6):919-23. doi: 10.1007/s00464-005-0534-6. Epub 2006 May 2.
The aim of this study was to analyze the results of pleurodesis for malignant pleural effusion performed by surgeons.
A series of 273 patients with malignant pleural effusion underwent thoracoscopy with the aim of performing a palliative pleurodesis. There were 94 males (34.4%) and 175 females (64.1%), ranging in age from 15 to 94 years (mean age: 60.6 years). The effusion was on the right side in 136 patients (49.8%), on the left side in 110 (40.3%), and bilateral in 27 (9.9%). Thoracoscopy was performed under general anaesthesia in all patients. Pleural biopsy was performed in two thirds of the patients (70.7%). Pleurodesis was produced by instillation of 5g of sterile asbestos-free talc; the chest tube was left in place a minimum of 3 days. It was removed when fluid drainage was less than 200 ml/24 h. Patients were usually discharged the day after chest tube removal.
There was no intraoperative mortality. Two patients (0.7%) had intraoperative complications; 17 (6.2%) underwent a bilateral pleurodesis, and 10 (3.7%) had a pericardiopleural window. In 32 patients (11.7%) no pleurodesis was done, either because the lung did not properly re-expand (5.2%), or because of suspected infection, e.g., false membranes (1.9%), or because of multiple adhesions (4.6%). Finally, only 241 patients (88.3%) had a talc poudrage at the time of thoracoscopy. Duration of postoperative pleural drainage ranged between 1 and 11 days (mean: 3.64 days). The postoperative hospital stay ranged from 2 to 21 days (mean: 7.1 days). Pleural empyema occurred in 4 patients (1.5%) and was lethal in one patient. The mean follow-up period was 8.39 (7.2 months, and 172 patients had regular follow up. In this group, there were 24 recurrences (14%), 12 of which were treated by repeat pleurodesis. The results were very good in 133 patients (77.3%), acceptable in 35 patients (20.3%), and there was a failure in 4 patients (2.4%).
Results of surgical thoracoscopy for malignant pleural effusion are good, with low morbidity. However, in debilitated patients, bedside talc slurry may be preferable.
本研究旨在分析外科医生进行恶性胸腔积液胸膜固定术的结果。
一系列273例恶性胸腔积液患者接受了胸腔镜检查，目的是进行姑息性胸膜固定术。其中男性94例（34.4%），女性175例（64.1%），年龄在15至94岁之间（平均年龄：60.6岁）。胸腔积液位于右侧136例（49.8%），左侧110例（40.3%），双侧27例（9.9%）。所有患者均在全身麻醉下进行胸腔镜检查。三分之二的患者（70.7%）进行了胸膜活检。通过注入5g无菌无石棉滑石粉进行胸膜固定术；胸管至少留置3天。当引流量少于200ml/24小时时拔除胸管。患者通常在拔除胸管后的次日出院。
无术中死亡。2例患者（0.7%）出现术中并发症；17例（6.2%）进行了双侧胸膜固定术，10例（3.7%）有胸膜心包开窗术。32例患者（11.7%）未进行胸膜固定术，原因要么是肺未完全复张（5.2%），要么是怀疑感染，如假膜形成（1.9%），要么是存在多处粘连（4.6%）。最后，仅241例患者（88.3%）在胸腔镜检查时进行了滑石粉喷洒。术后胸腔引流持续时间为1至ll天（平均：3.64天）。术后住院时间为2至21天（平均：7.1天）。4例患者（1.5%）发生了胸腔积脓，其中1例死亡。平均随访期为8.39个月（7.2个月至172个月），172例患者接受了定期随访。在该组中，有24例复发（14%），其中12例通过重复胸膜固定术进行了治疗。133例患者（77.3%）结果非常好，35例患者（20.3%）结果尚可，4例患者（2.4%）治疗失败。
恶性胸腔积液的外科胸腔镜检查结果良好，发病率低。然而，对于身体虚弱的患者，床边滑石粉悬液可能更可取。
