Inoue Takeo, Ishida Atsuko, Nakamura Miho, Nishine Hiroki, Mineshita Masamichi, Miyazawa Teruomi
Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Japan.
Intern Med. 2013;52(11):1173-6. doi: 10.2169/internalmedicine.52.9281.
Malignant pleural effusions are commonly treated with tube drainage followed by chemical pleurodesis to maintain the patient's quality of life. While talc is now accepted to be a worldwide gold-standard sclerosing agent for treating malignant pleural effusion, it is not yet approved in Japan. Instead, many patients are administered OK-432 for pleurodesis, which carries the risk of complications such as high-grade fever, chest pain, anaphylactic shock, interstitial pneumonia and acute renal failure. To assess the efficacy and safety of talc as a sclerosing agent in the management of malignant pleural effusions in Japanese patients.
Pleurodesis was performed using 4 g of sterile talc with thoracoscopic talc poudrage or the administration of talc slurry via a chest tube in patients with malignant pleural effusions.
A total of 57 patients were included. The success rate of pleurodesis assessed on chest radiography at 30, 90 and 180 days was 90.6%, 80.9% and 76.1%, respectively. Complications occurring after talc pleurodesis included fever in 10.5% of the patients and chest pain in 14.0% of the patients. No major complications were reported.
Talc pleurodesis is an effective and safe treatment for the management of malignant pleural effusion in Japanese patients.
恶性胸腔积液通常采用胸腔闭式引流，随后进行化学性胸膜固定术以维持患者生活质量。虽然滑石粉目前被公认为是治疗恶性胸腔积液的全球金标准硬化剂，但在日本尚未获批。取而代之的是，许多患者接受了用于胸膜固定术的溶链菌制剂OK-432治疗，这存在诸如高热、胸痛、过敏性休克、间质性肺炎和急性肾衰竭等并发症风险。旨在评估滑石粉作为硬化剂治疗日本患者恶性胸腔积液的有效性和安全性。
对恶性胸腔积液患者，通过胸腔镜滑石粉喷洒或经胸管注入滑石粉悬液，使用4g无菌滑石粉进行胸膜固定术。
共纳入57例患者。在第30、90和180天通过胸部X线评估的胸膜固定术成功率分别为90.6%、80.9%和76.1%。滑石粉胸膜固定术后发生的并发症包括10.5%的患者出现发热和14.0%的患者出现胸痛。未报告重大并发症。
滑石粉胸膜固定术是治疗日本患者恶性胸腔积液的一种有效且安全的方法。
