Sioris T, Sihvo E, Salo J, Räsänen J, Knuuttila A
Heart Center, Tampere University Hospital, P.O. Box 2000, FIN-33521 Tampere, Finland.
Eur J Surg Oncol. 2009 May;35(5):546-51. doi: 10.1016/j.ejso.2008.06.009. Epub 2008 Jul 21.
Talc pleurodesis using talc slurry via chest tube is a primary option in malignant pleural effusion, since life expectancy is short and surgical decortication is hazardous. Incomplete lung expansion after fluid evacuation, and/or excessive fluid secretion predicts failure of pleurodesis. A mini-invasive alternative was investigated.
Between March 2004 and September 2005, 51 consecutive patients with malignant pleural effusion, and clinically considered unsuitable for talc pleurodesis, received an indwelling pleural catheter (Denver PleurX). In 47, implantation was done bedside using local anaesthesia. There were 24 men and 27 women, median age 63 (range 36-85) years, receiving 39 right side, 10 left side, and 2 bilateral catheters. There were 19 non-small cell lung cancer cases, 7 mesothelioma, and 25 with other malignancy. Chemotherapy was being given to 18 patients and was not interrupted.
Discharge to home was possible in 71% (36 of 71 patients) on the following day. At 2 years follow-up in September 2007, one patient was alive. Mean survival was 3 months (range 5 days to 37+months) for all patients, with best median survivals of 5.5-6 months in breast and ovarian cancer. Catheter was removed or replaced in 15% (8 of 51 patients) due to infection, air leak, or blockage. One patient requested decortication for excessive fluid secretion. None required surgery or died due to catheter-related complications. Pleural fusion with subsequent catheter removal was achieved in 21% (11 of 51 patients).
An indwelling pleural catheter is a safe alternative for patients with malignant pleural effusion unsuitable for talc pleurodesis. In some, pleural fusion may be achieved.
对于恶性胸腔积液患者，由于预期寿命短且手术剥除胸膜有风险，经胸管注入滑石粉乳剂进行滑石粉胸膜固定术是主要选择。液体引流后肺扩张不全和/或液体分泌过多预示着胸膜固定术会失败。因此研究了一种微创替代方法。
在2004年3月至2005年9月期间，51例连续的恶性胸腔积液患者，临床认为不适合进行滑石粉胸膜固定术，接受了留置胸膜导管（丹佛PleurX）。47例在床边采用局部麻醉植入。其中男性24例，女性27例，中位年龄63岁（范围36 - 85岁），右侧植入39根导管，左侧植入10根，双侧植入2根。非小细胞肺癌19例，间皮瘤7例，其他恶性肿瘤25例。18例患者正在接受化疗且未中断。
71%（51例中的36例）患者于次日即可出院回家。在2007年9月的2年随访中，1例患者存活。所有患者的平均生存期为3个月（范围5天至37 +个月），乳腺癌和卵巢癌患者的最佳中位生存期为5.5 - 6个月。因感染、漏气或堵塞，15%（51例中的8例）患者的导管被拔除或更换。1例患者因液体分泌过多要求进行胸膜剥除术。无人因导管相关并发症需要手术或死亡。21%（51例中的11例）患者实现了胸膜粘连并随后拔除了导管。
对于不适合滑石粉胸膜固定术的恶性胸腔积液患者来说，留置胸膜导管是一种安全的替代方法。部分患者可实现胸膜粘连。
