Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
Respirology. 2011 Aug;16(6):891-9. doi: 10.1111/j.1440-1843.2011.02011.x.
Numerous intrapleural therapies have been adopted to treat a vast array of pleural diseases. The first intrapleural therapies proposed focused on the use of fibrinolytics and DNase to promote fluid drainage in empyema. Numerous case series and five randomized controlled trials have been published to determine the outcomes of fibrinolytics in empyema treatment. In the largest randomized trial, the use of streptokinase had no reduction in mortality, decortication rates or hospital days compared with placebo in the treatment of empyema. Criticism over study design and patient selection may have potentially affected the outcomes in this study. The development of dyspnoea is common in the setting of malignant pleural effusions. Pleural fluid evacuation followed by pleurodesis is often attempted. Numerous sclerosing agents have been studied, with talc emerging as the most effective agent. Small particle size of talc should be avoided because of increased systemic absorption potentiating toxicity, such as acute lung injury. Over the past several years, the use of chronic indwelling pleural catheters have emerged as the preferred modality in the treating a symptomatic malignant pleural effusion. For patients with malignant-related lung entrapment, pleurodesis often fails due to the presence of visceral pleural restriction; however, chronic indwelling pleural catheters are effective in palliation of dyspnoea. Finally, the use of staphylococcal superantigens has been proposed as a therapeutic model for the treatment of non-small lung cancer. Intrapleural instillation of staphylococcal superantigens increased median survival by 5 months in patients with non-small cell lung cancer with a malignant pleural effusion.
已经采用了许多胸膜内治疗方法来治疗各种胸膜疾病。最初提出的胸膜内治疗方法侧重于使用纤维蛋白溶解剂和 DNA 酶促进脓胸的液体引流。已经发表了许多病例系列和五项随机对照试验，以确定纤维蛋白溶解剂在脓胸治疗中的效果。在最大的随机试验中，与安慰剂相比，链激酶在治疗脓胸时并未降低死亡率、剥脱术率或住院天数。对研究设计和患者选择的批评可能会对该研究的结果产生影响。在恶性胸腔积液的情况下，呼吸困难的发展很常见。通常尝试进行胸腔积液排出后胸膜固定术。已经研究了许多硬化剂，滑石粉是最有效的药物。由于增加了全身吸收的毒性，例如急性肺损伤，应避免使用滑石粉的小颗粒尺寸。在过去的几年中，慢性留置胸膜导管的使用已成为治疗有症状的恶性胸腔积液的首选方法。对于患有恶性相关肺束缚的患者，由于存在内脏胸膜限制，胸膜固定术通常会失败；但是，慢性留置胸膜导管在缓解呼吸困难方面非常有效。最后，葡萄球菌超抗原的使用已被提议作为治疗非小细胞肺癌的治疗模型。葡萄球菌超抗原的胸膜内灌注使患有恶性胸腔积液的非小细胞肺癌患者的中位生存期延长了 5 个月。
