Burgers J A, Olijve A, Baas P
Nederlands Kanker Instituut-Antoni van Leeuwenhoek Ziekenhuis, afd. Thoracale Oncologie, Plesmanlaan 121, Amsterdam.
Ned Tijdschr Geneeskd. 2006 Jul 22;150(29):1618-23.
To describe the experience with an indwelling pleural catheter in patients with pleuritis carcinomatosa.
Prospective follow-up study.
The placement of an indwelling pleural catheter was considered as a treatment possibility for patients who presented with symptomatic accumulation of pleural fluid that returned following previous drainage or pleurodesis or when the fluid had not been drained off previously but there were strong radiological indications for a 'trapped lung'. The intervention was considered to be contraindicated by the following: dyspnoea that had not been reduced by previous pleural punctures performed for relief, dyspnoea caused by many different factors, a tendency for haemorrhaging that could not be corrected. The drain used was a Pleurx indwelling catheter, a thorax drain that is tunnelled subcutaneously, can remain in situ for a long time and offers the patient the opportunity to drain off fluid himself at any desired moment.
In the period September 2003-May 2005, the treatment was considered in 40 patients. Ultimately, the catheter was inserted in 25 patients; the clinical deterioration of most of the other patients was too quick. Of the group, 33 patients (82%) died with a median survival of 70 days. All catheters functioned until they were removed or until the patient died. In 3 patients, the drainage procedure was complicated by empyema and in 1 patient by haemoptysis. From the total number of catheters, 9 were removed while the patient was still alive and in 6 patients, spontaneous pleurodesis occurred following 3, 4, 4, 5, 6, and 8 months respectively. In general, the patients were able to handle the catheter without problems and the symptoms were brought and kept adequately under control.
The Pleurx indwelling pleural catheter was an efficacious treatment supplement for patients with malignant pleural effusion, in whom the standard pleurodesis was not effective.
描述留置胸膜导管在癌性胸膜炎患者中的应用经验。
前瞻性随访研究。
对于出现有症状的胸腔积液且在先前胸腔引流或胸膜固定术后积液复发的患者，或者先前未进行引流但有强烈影像学证据提示“肺陷闭”的患者，将留置胸膜导管置入术视为一种治疗选择。以下情况被视为该干预措施的禁忌证：先前为缓解呼吸困难而进行的胸腔穿刺未能减轻呼吸困难、由多种不同因素引起的呼吸困难、无法纠正的出血倾向。所使用的引流管为Pleurx留置导管，这是一种经皮下隧道置入的胸腔引流管，可长期留置原位，并使患者有机会在任何需要时自行引流积液。
在2003年9月至2005年5月期间，对40例患者进行了该治疗评估。最终，25例患者置入了导管；其他大多数患者临床病情恶化过快。该组中，33例患者（82%）死亡，中位生存期为70天。所有导管在拔除或患者死亡前均发挥了作用。3例患者的引流过程并发脓胸，1例患者并发咯血。在所有导管中，9根在患者仍存活时被拔除，6例患者分别在3、4、4、5、6和8个月后出现自发性胸膜固定术。总体而言，患者能够顺利操作导管，症状得到并持续得到充分控制。
对于标准胸膜固定术无效的恶性胸腔积液患者，Pleurx留置胸膜导管是一种有效的治疗补充手段。
