Stather David Ryan, Tremblay Alain
University of Calgary, Calgary, Alberta, Canada.
Curr Opin Pulm Med. 2007 Jul;13(4):328-33. doi: 10.1097/MCP.0b013e328121447d.
Malignant pleural effusion is a common complication in advanced malignancy that causes debilitating symptoms which result in impaired quality of life. The primary therapeutic goal in malignant pleural effusion management is effective palliation of the associated respiratory symptoms. Pleurodesis by chest tube or thoracoscopy is widely accepted as the gold standard treatment, although these treatments are not without problems. Tunneled pleural catheters represent a new safe and effective outpatient treatment option for these patients, with no reported mortality and minimal morbidity.
Chest tube insertion with talc slurry and thoracoscopy with talc insufflation are effective methods for achieving spontaneous pleurodesis, although associated with significant morbidity and mortality. A growing body of evidence is confirming that long-term palliation of malignant pleural effusion can be achieved by using tunneled pleural catheters in a large proportion of relatively unselected patients on an outpatient basis.
The optimal method for palliative management of malignant pleural effusion remains controversial. The high success rates, low complication rates and efficacy in patients with a wide range of performance status support the use of tunneled pleural catheters as a first-line treatment for symptomatic malignant pleural effusion.
恶性胸腔积液是晚期恶性肿瘤的常见并发症，可导致使人衰弱的症状，进而损害生活质量。恶性胸腔积液管理的主要治疗目标是有效缓解相关的呼吸道症状。通过胸管或胸腔镜进行胸膜固定术被广泛认为是金标准治疗方法，尽管这些治疗并非没有问题。隧道式胸腔导管为这些患者提供了一种新的安全有效的门诊治疗选择，尚无死亡报告，发病率也极低。
注入滑石粉浆的胸管置入术和滑石粉吹入法胸腔镜检查是实现自发性胸膜固定术的有效方法，尽管会伴有显著的发病率和死亡率。越来越多的证据证实，对于大部分相对未经筛选的患者，在门诊使用隧道式胸腔导管可实现恶性胸腔积液的长期缓解。
恶性胸腔积液姑息治疗的最佳方法仍存在争议。隧道式胸腔导管成功率高、并发症发生率低，且对各种身体状况的患者均有效，支持将其作为有症状恶性胸腔积液的一线治疗方法。
