乳腺癌所致胸腔积液的胸腔内置管引流治疗。

Prolonged pleural catheters in the management of pleural effusions due to breast cancer.

机构信息

Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty, Istanbul, Turkey.

Department of Medical Oncology, Istanbul Bilim University Medical Faculty, Istanbul, Turkey.

出版信息

J Thorac Dis. 2014 Feb;6(2):74-8. doi: 10.3978/j.issn.2072-1439.2013.12.38.

DOI:10.3978/j.issn.2072-1439.2013.12.38

PMID:24605219

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3944175/

Abstract

BACKGROUND

Breast cancer is the second most common etiologic cause in malignant pleural effusions (MPE). The aim of this study was to investigate the efficacy of long term pleural catheters in inducing self sclerosis in pleural effusions of breast cancer patients.

METHODS

In this study, 26 patients with breast cancer relapleural effusions that occurred between January 2011 and July 2013, who were considered not to undergo any other treatments and managed with prolonged pleural catheters (Jackson-Pratt silicone flat drain), were retrospectively analyzed. Thirty pleural catheters were inserted in 26 patients. All patients were female, mean age was 52 (range, 37-66) years old. Drainage over 1,500 mL per day was not allowed in order to avoid a lung edema. The catheters were removed in patients who had restoration of lung expansion and drainage under 50 mL/day.

RESULTS

The histologic subtypes in pleural effusions were invasive ductal carcinoma in 18 patients, ductal carcinoma in situ in 4, invasive lobular carcinoma in 2, tubular carcinoma in 1, and medullary carcinoma in 1. Three of the 26 patients underwent bilateral catheter insertion, and one patient underwent a reinsertion of the catheter into the same hemithorax due to a recurrence. The catheters were retained for a mean period of 18 days (range, 11-38 days). In one patient with invasive ductal carcinoma and paramalignant pleural effusion (PMPE) (3.8%), a recurrent pleural effusion was seen 34 days after removal of the catheter. There were no complications. One patient died while the catheter was in place.

CONCLUSIONS

Prolonged catheters for the management of pleural effusions in selected patients have become more popular than other treatment alternatives due to a shorter length of stay and lower costs. We recommend the use of Jackson Pratt (JP) silicone flat drains which in our opinion provide effective pleurodesis in addition to easy application in recurrent effusions caused by breast cancer.

摘要

背景

乳腺癌是恶性胸腔积液（MPE）的第二大常见病因。本研究旨在探讨长期胸腔引流管在诱导乳腺癌患者胸腔积液自硬化中的疗效。

方法

本研究回顾性分析了 2011 年 1 月至 2013 年 7 月期间 26 例复发性乳腺癌伴胸腔积液患者，这些患者被认为不能接受任何其他治疗，只能采用长期胸腔引流管（Jackson-Pratt 硅酮平引流管）进行治疗。26 例患者共插入 30 根胸腔引流管。所有患者均为女性，平均年龄为 52 岁（范围，37-66 岁）。为避免肺水肿，每天引流量不超过 1500ml。当患者肺部扩张恢复且引流量每天少于 50ml 时，将引流管拔出。

结果

胸腔积液的组织学亚型为浸润性导管癌 18 例，导管原位癌 4 例，浸润性小叶癌 2 例，管状癌 1 例，髓样癌 1 例。26 例患者中有 3 例行双侧导管插入术，1 例因复发在同一胸腔内重新插入导管。引流管留置时间平均为 18 天（范围，11-38 天）。在 1 例浸润性导管癌伴恶性间皮瘤性胸腔积液（PMPE）（3.8%）患者中，导管拔出后 34 天出现复发性胸腔积液。无并发症发生。1 例患者在放置引流管时死亡。