University of Torino, Department of Thoracic Surgery, San Giovanni Battista Hospital, Via Genova 3, Turin, Italy.
Eur J Surg Oncol. 2011 Dec;37(12):1093-8. doi: 10.1016/j.ejso.2011.09.037. Epub 2011 Oct 1.
In cancer patients with malignant pleural effusions(MPEs),the commonest procedure to treat them with palliative intention is talc pleurodesis (TP) which can be obtained with talc slurry (TS) using small-bore catheters(SBC)or with thoracoscopic poudrage. SBC use is therefore rapidly increasing. The aim of this paper is to present our preliminary TP results using a new percutaneous chest drainage system(UNICO®, Redax, Mirandola Modena, Italy).
In the period 1st March-20th of July 2011,seven consecutive ECOG PS 3-4 patients(4 females, mean age 73.2 ± 12.1 years),unfit for thoracoscopic talc poudrage, were enrolled in our study. All patients received many thoracentesis before the placement of a chest drainage(median thoracentesis number:4.42 ± 1.13).UNICO® was bedside placed in all cases and TS was administered through the drainage when the overall fluid amount didn't exceed 150-200 ml/24 h and the lung was correctly re-expanded at the chest X-ray control.
There were no clinical complications following the placement of the drainage: its placement was easy, safe and well-tolerated by all patients. The median chest tube stay, before TS, was 7.2 ± 2.7 days while the median chest tube stay after TS was 1.5 ± 0.7 days. A satisfactory radiological lung expansion was achieved in all cases; PL effectiveness and dyspnea relief were complete in 6 and 4 cases, respectively. No patients required any further thoracentesis.
TS through UNICO® is safe and efficient. The drainage was well-tolerated by all patients, even in case of its long-term stay. We may conclude that bedside TS through this new small-bore percutaneous drainage should be proposed as a viable clinical solution for MPEs in ECOG PS 3-4 patients, unfit for a thoracoscopic procedure. Moreover, with this device, we believe that TS might be an accessible procedure for pulmonologists and oncologists too.
在患有恶性胸腔积液（MPE）的癌症患者中，最常见的姑息性治疗方法是滑石粉胸膜固定术（TP），可通过小口径导管（SBC）用滑石粉浆（TS）或胸腔镜滑石粉喷洒来进行。因此，SBC 的使用正在迅速增加。本文旨在介绍我们使用新型经皮胸腔引流系统（UNICO®，Redax，Mirandola Modena，意大利）进行初步 TP 的结果。
在 2011 年 3 月 1 日至 7 月 20 日期间，连续纳入 7 例 ECOG PS 3-4 分的患者（4 例女性，平均年龄 73.2 ± 12.1 岁），因不适合胸腔镜滑石粉喷洒而接受治疗。所有患者在放置胸腔引流前均接受了多次胸腔穿刺（中位数：4.42 ± 1.13）。所有病例均床边放置 UNICO®，当总液体量不超过 150-200ml/24h 且胸部 X 线检查显示肺正确复张时，通过引流管给予 TS。
引流管放置后无临床并发症：所有患者均能轻松、安全地耐受。在给予 TS 之前，胸腔引流管的中位留置时间为 7.2 ± 2.7 天，而在给予 TS 之后，胸腔引流管的中位留置时间为 1.5 ± 0.7 天。所有病例均达到了满意的肺部扩张；6 例患者的 PL 疗效和呼吸困难缓解完全，4 例患者的 PL 疗效和呼吸困难缓解完全。无患者需要进一步行胸腔穿刺术。
通过 UNICO®给予 TS 是安全有效的。所有患者均能耐受引流管，即使引流管长期留置也能耐受。我们可以得出结论，对于 ECOG PS 3-4 分、不适合胸腔镜手术的 MPE 患者，床边通过这种新型小口径经皮引流管给予 TS 可作为一种可行的临床治疗方法。此外，我们认为，对于肺病专家和肿瘤学家来说，通过这种设备进行 TS 也是可行的。
