Gross Jefferson Luiz, Younes Riad Naim, Deheinzelin Daniel, Diniz Alessandro Landskron, Silva Rodrigo Afonso da, Haddad Fabio José
Department of Thoracic Surgery, Hospital do Cancer A. C. Camargo, Rua Professor Antonio Prudente, 211 Liberdade, São Paulo, SP, 01509-010, Brazil.
Ann Surg Oncol. 2006 Dec;13(12):1732-8. doi: 10.1245/s10434-006-9073-1. Epub 2006 Oct 7.
Symptomatic pericardial effusion in patients with cancer may lead to a life-threatening event that requires diligent treatment, but the best surgical treatment is still controversial. The purpose of this study was to identify predictors of survival for patients with solid malignancies and symptomatic pericardial effusion, which might help to select the best surgical treatment for each patient.
We retrospectively analyzed 47 patients with solid malignancies concomitant with symptomatic pericardial effusion who underwent surgery between 1994 and 2004. Overall survival was calculated from date of surgery, and prognostic importance of clinical and pathological variables was assessed.
The most common primary sites of disease were breast (46.8%) and lung (25.6%). Initial pericardiocentesis were performed in 29 patients; median volume of fluid drained was 480 mL. Median interval from the diagnosis of primary cancer to the development of pericardial effusion (pericardial effusion-free interval) was 34.8 months. Definitive surgical treatment was performed in 43 patients, as follows: subxiphoid pericardial window (n = 21); thoracotomy and pleuropericardial window (n = 10); pericardiodesis (n = 8); and videothoracoscopic pleuropericardial window (n = 4). Pericardiocentesis was the only procedure in four patients. Median follow-up was 2.9 months. Median overall survival was 3.7 months. Pericardial effusion-free interval longer than 35 months and more than 480 mL of fluid drained at initial pericardiocentesis were determinants of better survival.
Pericardial window and pericardiodesis seem to be safe and efficacious in treating effusion of the pericardium. Pericardial effusion-free interval and volume drained at initial pericardiocentesis are determinants of outcome.
癌症患者出现症状性心包积液可能导致危及生命的情况，需要积极治疗，但最佳手术治疗方法仍存在争议。本研究的目的是确定实体恶性肿瘤合并症状性心包积液患者的生存预测因素，这可能有助于为每位患者选择最佳手术治疗方案。
我们回顾性分析了1994年至2004年间接受手术的47例实体恶性肿瘤合并症状性心包积液患者。从手术日期计算总生存期，并评估临床和病理变量的预后重要性。
最常见的疾病原发部位是乳腺（46.8%）和肺（25.6%）。29例患者进行了初始心包穿刺术；引流液的中位数体积为480 mL。从原发性癌症诊断到心包积液发生的中位间隔时间（无心包积液间隔时间）为34.8个月。43例患者进行了确定性手术治疗，如下：剑突下心包开窗术（n = 21）；开胸胸膜心包开窗术（n = 10）；心包固定术（n = 8）；电视胸腔镜胸膜心包开窗术（n = 4）。4例患者仅接受了心包穿刺术。中位随访时间为2.9个月。中位总生存期为3.7个月。无心包积液间隔时间超过35个月以及初始心包穿刺术引流液超过480 mL是生存较好的决定因素。
心包开窗术和心包固定术在治疗心包积液方面似乎是安全有效的。无心包积液间隔时间和初始心包穿刺术引流液体积是预后的决定因素。
