Zalcman Gérard, Lechapt Emmanuèle, Bergot Emmanuel
Service de pneumologie & ER INSERM Cancers et Populations, service de pneumologie, CHU Côte de Nacre.
Rev Prat. 2007 Mar 15;57(5):513-23.
Malignant pleural effusions are the major cause of pleural effusions in patients older than 40. Their treatment is essentially palliative but recently improved with new efficient chemotherapy. The most frequent causes of malignant pleural effusions are pleural metastatic adenocarcinomas arising from lung in both sex, or from breast in women, and malignant mesothelioma. In both cases, thoracoscopy is useful for histological biopsies and sclerotherapy by talc poudrage. Pleural malignant mesotheliomas are linked in 70% of cases to professional asbestosis exposure. The histological diagnosis is difficult, relying on a standardized immunohistochemical analysis. Prophylactic irradiation has been proved to be efficient in the prevention of parietal seeding along the thoracocentesis and drainage channels. PET imaging could be of major interest in the diagnosis of mesothelioma and prognosis evaluation. Mesothelioma prognosis has recently been modified by the association of cisplatin with pemetrexed, a new antimetabolite agent, but mesothelioma remains seldom curable.
恶性胸腔积液是40岁以上患者胸腔积液的主要原因。其治疗本质上是姑息性的，但最近随着新型高效化疗而有所改善。恶性胸腔积液最常见的原因是两性中源自肺部的胸膜转移性腺癌，或女性中源自乳腺的胸膜转移性腺癌，以及恶性间皮瘤。在这两种情况下，胸腔镜检查对于组织活检和滑石粉喷洒硬化治疗都很有用。70%的胸膜恶性间皮瘤病例与职业性石棉沉着病暴露有关。组织学诊断困难，依赖于标准化的免疫组化分析。预防性放疗已被证明在预防沿胸腔穿刺和引流通道的壁层种植方面有效。PET成像在间皮瘤的诊断和预后评估中可能具有重要意义。顺铂与一种新型抗代谢药物培美曲塞联合使用最近改变了间皮瘤的预后，但间皮瘤仍然很少能治愈。
