Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, Faculty of Medicine and Surgery, University of L'Aquila, Piazza Italia 1, 64100 Teramo, Italy.
Biomed Res Int. 2013;2013:295890. doi: 10.1155/2013/295890. Epub 2013 Sep 1.
Chemical pleurodesis is the procedure of choice in the management of recurrent malignant pleural effusions (MPE). Talc is probably the most effective sclerosant, with a success rate of 80%. The aim of this study is to demonstrate the effectiveness of silver nitrate solution (SNS) pleurodesis after an unsuccessful thoracoscopic talc poudrage.
Between 2011 and 2013 one hundred and nine patients with unilateral MPE underwent thoracoscopic talc poudrage. Seventeen patients who did not obtain a successful pleurodesis via thoracoscopic procedure were considered for an SNS slurry. The pleural injectate consisted of 100 mL 1% SNS with 10 mL of lidocaine (100 mg/5 mL). The SNS procedure was undertaken once and repeated with the same dose in 5 patients.
The duration of follow-up period was 30 days. Subjective pain was low and the same before and after SNS procedure (P value = NS). The mean daily fluid drainage was statistically different (P = 0.001) comparing values before (597.0 ± 122.8 mL) and after SNS procedure (109.1 ± 22.3 mL). After 30 days from SNS procedure recurrence of pleural effusion was observed in 2 patients (11%).
The present study demonstrates that SNS is an effective agent for producing pleurodesis after a failed thoracoscopic talc poudrage.
在复发性恶性胸腔积液（MPE）的治疗中，化学性胸膜固定术是首选方法。滑石粉可能是最有效的硬化剂，成功率为 80%。本研究旨在证明硝酸银溶液（SNS）胸膜固定术在胸腔镜滑石粉撒布术失败后的有效性。
2011 年至 2013 年间，109 例单侧 MPE 患者接受了胸腔镜滑石粉撒布术。17 例经胸腔镜手术未能成功胸膜固定术的患者被考虑使用 SNS 混悬液。胸腔内注射物由 100mL1%SNS 和 10mL 利多卡因（100mg/5mL）组成。SNS 程序进行了一次，5 名患者用相同剂量重复进行。
随访期为 30 天。主观疼痛低，SNS 前后相同（P 值=NS）。平均每日液体引流在统计学上有差异（P=0.001），比较 SNS 程序前后的值（597.0±122.8mL）和 SNS 程序后的值（109.1±22.3mL）。SNS 程序后 30 天，2 例（11%）患者出现胸腔积液复发。
本研究表明，SNS 是胸腔镜滑石粉撒布术失败后产生胸膜固定术的有效药物。
