Suárez P M Rodríguez, Gilart J L Freixinet
Servicio de Cirugía Torácica, Hospital Universitario de Gran Canaria "Dr. Negrín", Las Palmas de Gran Canaria, España.
Monaldi Arch Chest Dis. 2013 Jun;79(2):81-6. doi: 10.4081/monaldi.2013.96.
Malignant pleural effusion and persistent and/or recurrent spontaneous pneumothorax are clinical entities requiring pleurodesis to avoid the accumulation of liquid and air, respectively. The objectives are to alleviate symptoms (dyspnea, pain and cough), decrease prolonged air leak, avoid recurrence and improve quality of life. Chemical pleurodesis utilizes chemical irritants. The most common of these is "talc" because of its efficiency and its success in lowering the rate of recurrence. Its main indication is in the palliative treatment of malignant pleural effusion. Other substances less frequently used because they are rarely used currently or under study are cytostatics, antibiotics, antiseptics and autologous blood. Surgical pleurodesis with mechanical abrasion by videothoracoscopy is indicated primarily in the treatment of spontaneous pneumothorax because it is highly efficient, easy to carry out, and has low morbidity when compared to pleurectomy. Using pleurodesis in benign effusion is highly controversial. Its principal indications are hepatic hydrothorax, chylothorax, and cardiac effusion that does not respond to medical treatment. Plasma determinations of systemic inflammatory markers and thoracic ultrasound studies can evaluate the efficacy of pleurodesis. We do not recommend the use of non-steroidal anti-inflammatory drugs in the postoperative period to avoid the possibility of interfering with hemostasis or the formation of adherences.
恶性胸腔积液以及持续性和/或复发性自发性气胸是需要进行胸膜固定术的临床病症，分别用于避免液体和空气的积聚。目的是缓解症状（呼吸困难、疼痛和咳嗽），减少持续的气胸漏气，避免复发并提高生活质量。化学性胸膜固定术使用化学刺激剂。其中最常用的是“滑石粉”，因为它有效且能成功降低复发率。其主要适应证是恶性胸腔积液的姑息治疗。其他较少使用的物质，因为它们目前很少使用或正在研究中，包括细胞抑制剂、抗生素、防腐剂和自体血。通过电视胸腔镜进行机械摩擦的手术性胸膜固定术主要用于治疗自发性气胸，因为它效率高、易于实施，与胸膜切除术相比发病率低。在良性胸腔积液中使用胸膜固定术存在很大争议。其主要适应证是肝性胸水、乳糜胸以及对内科治疗无反应的心脏积液。全身炎症标志物的血浆测定和胸部超声检查可以评估胸膜固定术的疗效。我们不建议在术后使用非甾体类抗炎药，以避免干扰止血或粘连形成的可能性。
