Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
J Vasc Interv Radiol. 2010 May;21(5):696-700. doi: 10.1016/j.jvir.2010.01.021. Epub 2010 Mar 21.
To evaluate patient outcomes when tunneled pleural drainage catheters are placed for symptomatic, recurrent malignant pleural effusion following failed chemical pleurodesis.
Two hundred seventy patients who underwent placement of a tunneled pleural catheter between January 2002 and December 2006 were retrospectively identified by reviewing interventional radiology billing records with institutional review board approval. Of these 270 patients, 63 (68 hemithoraces; 44 women, 19 men) with dyspnea were referred for tunneled pleural drainage catheter placement following failed pleurodesis for malignant pleural effusion. Clinical and procedural details were identified by chart review. Endpoints were technical success, symptomatic improvement in dyspnea, time to hospital discharge, and time to catheter removal or time to death with the catheter in place.
Clinical improvement in dyspnea was noted in 60 of the 63 patients (95%). Fifty-seven of the 63 patients (90%) were discharged with their catheter in place after a median of 3 days (range, 0-29 days). Twenty-seven of the 63 patients (43%) were discharged in 2 days or less. Stays longer than 2 days were all associated with treatment of other medical problems. Twenty-one of the 68 catheters (31%) required fibrinolytic therapy for optimal evacuation of complex pleural collections. Eleven of the 68 catheters (16%) could subsequently be removed due to durable resolution of pleural effusion. The remaining patients died with catheters in place and no clinical evidence of catheter dysfunction after a median of 58 days.
Even following failed pleurodesis, recurrent malignant pleural effusions can be effectively managed with placement of tunneled pleural catheters.
评估在化学性胸膜固定术失败后，因症状性复发性恶性胸腔积液而放置经皮胸膜腔引流导管的患者结局。
通过机构审查委员会批准的回顾性介入放射学计费记录，鉴定出 2002 年 1 月至 2006 年 12 月期间行经皮胸膜腔引流导管置入术的 270 例患者。在这 270 例患者中，63 例（68 侧胸腔；44 例女性，19 例男性）因恶性胸腔积液化学性胸膜固定术失败后出现呼吸困难而被转诊行经皮胸膜腔引流导管置入术。通过病历回顾确定临床和操作细节。终点是技术成功率、呼吸困难症状改善、出院时间、导管拔除时间或带管死亡时间。
在 63 例患者中，60 例（95%）呼吸困难得到改善。63 例患者中有 57 例（90%）在中位 3 天（范围 0-29 天）内带着导管出院。27 例患者（43%）在 2 天或更短时间内出院。住院时间超过 2 天的患者均与治疗其他医疗问题有关。68 个导管中有 21 个（31%）需要纤维蛋白溶解治疗以最佳排空复杂的胸腔积液。11 个导管（16%）随后因胸腔积液持久缓解而被拔除。其余患者在带管中位 58 天后死亡，且无导管功能障碍的临床证据。
即使在化学性胸膜固定术失败后，复发性恶性胸腔积液也可以通过放置经皮胸膜腔引流导管有效治疗。
