聚维酮碘胸膜固定术与滑石粉胸膜固定术预防恶性胸腔积液复发的比较
Povidone-iodine pleurodesis versus talc pleurodesis in preventing recurrence of malignant pleural effusion.
作者信息
Ibrahim Islam M, Dokhan Ahmed L, El-Sessy Alaa A, Eltaweel Mohammed F
机构信息
Cardiothoracic surgery department, Faculty of Medicine, Menoufia University, Yassin Abd El-Ghaffar Street, 32511, Shepin El-Kom, Menoufia, Egypt.
General surgery department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
出版信息
J Cardiothorac Surg. 2015 May 1;10:64. doi: 10.1186/s13019-015-0270-5.
BACKGROUND
Malignant pleural effusions continue to be a common problem in patients with metastatic disease, leading to a significant reduction in quality of life with progressive dyspnea, dry cough, chest pain and reduced physical activity. This study was conducted to compare the efficacy, safety, and outcome of Talc Powder Pleurodesis (TPP) with Povidone-iodine Pleurodesis (PIP) through a chest drain as a palliative preventive treatment of recurrent malignant pleural effusion.
METHODS
A total of 39 neoplastic patients with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Twenty-one patients received Talc pleurodesis (group A), and eighteen patients (group B) received Povidone-iodine pleurodesis. The continuous variables were expressed as mean values ± standard deviation (SD) and compared using the unpaired t-test. The discrete variables were expressed as percentage and compared using the chi-square test (χ(2)) test. p-values of less than 0.05 were considered significant.
RESULTS
Our study included 11 males and 28 females, the mean age was (71.0 ± 5.0) years for group A and (70.9 ± 5.1) years for group B (non-significant). Post-procedure analgesic requirements were recorded in both groups. Four patients in each group had fever (>38°C) within 48 hours of the procedure. Both groups achieved good symptomatic relief. There were no in-hospital deaths. The mean post-procedure hospital stay was (4.7 ± 1.2) days for group A and (4.2 ± 1.0) for group B (non-significant). At follow-up recurrence of significant pleural effusion requiring intervention was noted in four and five patients in group A and group B, respectively (non-significant difference).
CONCLUSION
Povidone-iodine pleurodesis can be considered as a good alternative to Talc pleurodesis for recurrent malignant pleural effusion. The drug is available, cost effective, safe and can be administered through an intercostal drain and repeated if necessary.
背景
恶性胸腔积液仍是转移性疾病患者的常见问题，会导致生活质量显著下降，出现进行性呼吸困难、干咳、胸痛及体力活动减少。本研究旨在比较滑石粉胸膜固定术（TPP）与聚维酮碘胸膜固定术（PIP）通过胸腔引流作为复发性恶性胸腔积液姑息性预防性治疗的疗效、安全性及结果。
方法
39例复发性恶性胸腔积液的肿瘤患者纳入一项前瞻性随机试验。21例患者接受滑石粉胸膜固定术（A组），18例患者（B组）接受聚维酮碘胸膜固定术。连续变量以平均值±标准差（SD）表示，并使用非配对t检验进行比较。离散变量以百分比表示，并使用卡方检验（χ(2)）进行比较。p值小于0.05被认为具有显著性。
结果
我们的研究包括11名男性和28名女性，A组平均年龄为（71.0±5.0）岁，B组为（70.9±5.1）岁（无显著性差异）。两组均记录了术后镇痛需求。每组各有4例患者在术后48小时内发热（>38°C）。两组均获得了良好的症状缓解。无院内死亡病例。A组术后平均住院时间为（4.7±1.2）天，B组为（4.2±1.0）天（无显著性差异）。随访时，A组和B组分别有4例和5例患者出现需要干预的大量胸腔积液复发（无显著性差异）。
结论
对于复发性恶性胸腔积液，聚维酮碘胸膜固定术可被视为滑石粉胸膜固定术的良好替代方法。该药物容易获得、具有成本效益、安全，可通过肋间引流给药，必要时可重复使用。
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