Neragi-Miandoab Siyamek
Thoracic and Cardiovascular Surgery, Loyola University Chicago, Stritch School of Medicine, 2160 South First Ave., Building 110, Room 6243, Maywood, IL 60153, USA.
Lung Cancer. 2006 Oct;54(1):1-9. doi: 10.1016/j.lungcan.2006.04.016. Epub 2006 Aug 7.
Malignant pleural effusion is a common and debilitating complication of advanced malignant diseases. This problem seems to affect particularly those with lung and breast cancer, contributing to the poor quality of life. Approximately half of all patients with metastatic cancer develop a malignant pleural effusion at some point, which is likely to cause significant symptoms such as dyspnea and cough. Evacuation of the pleural fluid and prevention of its re-accumulation are the main goals of management. Optimal treatment is controversial and there is no universally standard approach. Intervention options range from observation in the case of asymptomatic effusions through simple thoracentesis to more invasive methods such as chemical and mechanical pleurodesis, pleur-X catheter drainage, pleuroperitoneal shunting, and pleurectomy. The best results are reported with thoracoscopy and talc insufflation, with an acceptable morbidity. Development of novel methods to control malignant pleural effusion should be a high priority in palliative care of cancer patients. This article reviews the current, as well as, novel approaches that show some promise for the future. The aim is to identify the proper approach for each individual patient.
恶性胸腔积液是晚期恶性疾病常见且使人虚弱的并发症。这个问题似乎尤其影响肺癌和乳腺癌患者，导致生活质量低下。所有转移性癌症患者中约有一半在某个阶段会出现恶性胸腔积液，这很可能引发诸如呼吸困难和咳嗽等严重症状。胸腔积液的引流及防止其再次积聚是治疗的主要目标。最佳治疗方法存在争议，且没有普遍适用的标准方法。干预选项范围广泛，从无症状积液时的观察，到简单胸腔穿刺术，再到更具侵入性的方法，如化学和机械性胸膜固定术、Pleur-X导管引流、胸膜腹膜分流术和胸膜切除术。胸腔镜检查和滑石粉吹入法报告的效果最佳，且发病率可接受。开发控制恶性胸腔积液的新方法应是癌症患者姑息治疗中的高度优先事项。本文综述了当前以及显示出未来前景的新方法。目的是为每个患者确定合适的治疗方法。
