Luh S-P, Chen C-Y, Tzao C-Y
Cardiothoracic Surgery, Tzu-Chi General Hospital, No. 20, Lane 199, Sec. 2 Ba-De Road, Chung-Shan District, Taipei, Taiwan 104, Republic of China.
Thorac Cardiovasc Surg. 2006 Aug;54(5):332-6. doi: 10.1055/s-2006-923931.
Video-assisted thoracic surgery (VATS) has been widely used in the diagnosis and management of various thoracic diseases. The objective of this retrospective study was to compare the effectiveness of patients undergoing pleurodesis through VATS versus tube thoracostomy for malignant pleural effusion (MPE). Study design was a retrospective review of patients treated in medical centers and hospitals in Taiwan.
One hundred and forty-eight patients with MPE resistant to systemic therapy resulting from various types of carcinomas were retrospectively reviewed. VATS pleurodesis was carried out in 82 and tube thoracostomy with pleurodesis in 66 patients.
There were no intraoperative deaths and 4 (2.7 %) in-hospital deaths. One hundred and eighteen (79.7 %) patients were available for follow-up. There were no statistically significant differences in the preoperative characteristics of the two treatment groups, except that the amount of effusion and the percentage of patients with dyspnea were both higher in the VATS treatment group. The duration of chest tube drainage was significantly longer ( P < 0.01) in the tube thoracostomy treatment group (9.1 +/- 3.3 vs. 6.2 +/- 2.3 days). There were no significant differences between the treatment groups with regard to the incidence of surgical complications and perioperative mortality. Median survival was similar in both treatment groups; however, the VATS treatment group had a significantly longer median recurrence-free survival than the tube thoracostomy treatment group.
VATS treatment for MPE appears to be superior to tube thoracostomy for diagnostic accuracy and effectiveness in preventing effusion recurrence; however, the role of these treatments for MPE is palliative, and does not significantly prolong survival time.
电视辅助胸腔镜手术（VATS）已广泛应用于各种胸部疾病的诊断和治疗。本回顾性研究的目的是比较通过VATS进行胸膜固定术与胸腔闭式引流术治疗恶性胸腔积液（MPE）的效果。研究设计为对台湾医疗中心和医院治疗的患者进行回顾性分析。
回顾性分析了148例因各种类型癌症导致全身治疗耐药的MPE患者。82例行VATS胸膜固定术，66例行胸腔闭式引流术并胸膜固定术。
术中无死亡病例，住院死亡4例（2.7%）。118例（79.7%）患者可供随访。两个治疗组术前特征无统计学显著差异，但VATS治疗组的胸腔积液量和呼吸困难患者百分比均较高。胸腔闭式引流术治疗组的胸腔引流管留置时间明显更长（P<0.01）（9.1±3.3天对6.2±2.3天）。治疗组在手术并发症发生率和围手术期死亡率方面无显著差异。两个治疗组的中位生存期相似；然而，VATS治疗组的无复发生存期中位数明显长于胸腔闭式引流术治疗组。
VATS治疗MPE在诊断准确性和预防积液复发的有效性方面似乎优于胸腔闭式引流术；然而，这些治疗对MPE的作用是姑息性的，并未显著延长生存时间。
