Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 10, Houston, TX 77030-4009, USA.
J Gen Intern Med. 2011 Jan;26(1):70-6. doi: 10.1007/s11606-010-1472-0. Epub 2010 Aug 10.
Malignant pleural effusions (MPE) are a frequent cause of dyspnea and discomfort at the end of cancer patients' lives. The tunneled indwelling pleural catheter (TIPC) was approved by the FDA in 1997 and has been investigated as a treatment for MPE.
To systematically review published data on the efficacy and safety of the TIPC for treatment of MPE.
We searched the MEDLINE, EMBASE, and ISI Web of Science databases to identify studies published through October 2009 that reported outcomes in adult patients with MPE treated with a TIPC. Data were aggregated using summary statistics when outcomes were described in the same way among multiple primary studies.
Symptomatic improvement and complications associated with use of the TIPC.
Nineteen studies with a total of 1,370 patients met criteria for inclusion in the review. Only one randomized study directly compared the TIPC with the current gold standard treatment, pleurodesis. All other studies were case series. Symptomatic improvement was reported in 628/657 patients (95.6%). Quality of life measurements were infrequently reported. Spontaneous pleurodesis occurred in 430/943 patients (45.6%). Serious complications were rare and included empyema in 33/1168 patients (2.8%), pneumothorax requiring a chest tube in 3/51 (5.9%), and unspecified pneumothorax in 17/439 (3.9%). Minor complications included cellulitis in 32/935 (3.4%), obstruction/clogging in 33/895 (3.7%) and unspecified malfunction of the catheter in 11/121 (9.1%). The use of the TIPC was without complication in 517/591 patients (87.5%).
Based on low-quality evidence in the form of case series, the TIPC may improve symptoms for patients with MPE and does not appear to be associated with major complications. Prospective randomized studies comparing the TIPC to pleurodesis are needed before the TIPC can be definitively recommended as a first-line treatment of MPE.
恶性胸腔积液（MPE）是癌症患者生命末期呼吸困难和不适的常见原因。隧道式留置胸腔导管（TIPC）于 1997 年获得 FDA 批准，已被研究用于治疗 MPE。
系统评价 TIPC 治疗 MPE 的疗效和安全性的已发表数据。
我们检索了 MEDLINE、EMBASE 和 ISI Web of Science 数据库，以确定截至 2009 年 10 月发表的报告 MPE 成年患者使用 TIPC 治疗结果的研究。当多个主要研究以相同的方式描述结果时，使用汇总统计数据汇总数据。
TIPC 使用相关的症状改善和并发症。
19 项研究共纳入 1370 例患者，符合纳入标准。只有一项随机研究直接比较了 TIPC 与目前的金标准治疗方法胸膜固定术。所有其他研究均为病例系列研究。657 例患者中有 628 例（95.6%）报告症状改善。生活质量测量结果报告频率较低。439 例患者中有 430 例（45.6%）发生自发性胸膜固定。严重并发症罕见，包括 1168 例患者中有 33 例（2.8%）脓胸，51 例患者中有 3 例（5.9%）需要胸腔引流的气胸，439 例患者中有 17 例（3.9%）未特指的气胸。轻微并发症包括 935 例患者中有 32 例（3.4%）蜂窝织炎，895 例患者中有 33 例（3.7%）导管堵塞/阻塞和 121 例患者中有 11 例（9.1%）导管未特指的功能障碍。在 591 例患者中有 517 例（87.5%）使用 TIPC 无并发症。
基于病例系列的低质量证据，TIPC 可能改善 MPE 患者的症状，且似乎与主要并发症无关。需要前瞻性随机研究比较 TIPC 与胸膜固定术，才能明确推荐 TIPC 作为 MPE 的一线治疗方法。
