Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, Washington.
Ann Am Thorac Soc. 2015 Sep;12(9):1317-22. doi: 10.1513/AnnalsATS.201503-182OC.
Tunneled pleural catheters have been established to be safe and effective in the management of recurrent symptomatic pleural effusions. Obstruction of the tunneled pleural catheter is rare; however, when obstructed the catheter fails to achieve its primary goal of symptom palliation. The management of pleural catheter obstruction has not been studied.
We aimed to determine if the use of intracatheter fibrinolytic therapy is safe and effective in restoring catheter function.
One hundred seventy-two patients with tunneled pleural catheters placed from 2009 to 2014 were reviewed to identify patients who received fibrinolysis for catheter obstruction, defined by a sudden reduction to less than 10 ml in pleural fluid drainage with fluid visualized in the thorax on ultrasound/radiography. The technique involved intracatheter instillation of 2 to 5 mg of alteplase, which was allowed to remain in the catheter for 60 to 120 minutes, after which drainage was performed.
Obstruction occurred in 37 pleural catheters at a median of 2 months from insertion. One hundred percent (37/37) of obstructed catheters resumed drainage after fibrinolytic instillation, from a median of 4 ml before to 300 ml after fibrinolysis (P < 0.001). Twenty-four (65%) were performed in an outpatient setting, and no complications were encountered during or after fibrinolytic therapy. There were 18 episodes of reobstruction, all of which were successfully treated with intracatheter fibrinolytic therapy without complication.
Fibrinolytic instillation through a tunneled pleural catheter is safe and effective in restoring function of an obstructed catheter, as evidenced by the lack of complications and success in achieving catheter patency. The procedure can also be performed safely in an outpatient setting. Patients who experience catheter obstruction may be prone to reobstruction; however, fibrinolysis was safe and effective in reestablishing patency of the reobstructed catheter.
经皮隧道式胸腔引流管在治疗复发性症状性胸腔积液方面已被证实安全且有效。隧道式胸腔引流管发生阻塞较为罕见；然而，一旦发生阻塞，该引流管便无法达到缓解症状这一首要目标。目前尚未对胸腔引流管阻塞的处理方法进行研究。
我们旨在确定腔内溶栓疗法在恢复导管功能方面是否安全有效。
对 2009 年至 2014 年间置入的 172 例隧道式胸腔引流管患者进行回顾性分析，以确定因胸腔积液引流量突然减少至 10 ml 以下（经超声/放射影像学检查发现胸腔内仍有积液）而接受溶栓治疗的患者。该技术涉及向导管内注入 2 至 5 mg 的阿替普酶，然后将其保留在导管内 60 至 120 分钟，之后再进行引流。
在置入后中位数为 2 个月时，37 根胸腔引流管发生阻塞。在接受溶栓治疗后，所有 37 根阻塞的引流管均恢复了引流，从溶栓前的中位数 4 ml 增加到溶栓后的 300 ml（P < 0.001）。其中 24 例（65%）在门诊进行，在溶栓治疗过程中和治疗后均未发生并发症。有 18 例发生再阻塞，所有患者均通过腔内溶栓治疗成功治疗，且无并发症发生。
经皮隧道式胸腔引流管腔内溶栓安全有效，可恢复阻塞导管的功能，无并发症发生，且成功实现了导管通畅。该操作也可在门诊安全进行。发生导管阻塞的患者可能容易再次发生阻塞；然而，溶栓治疗在重新建立再阻塞导管的通畅性方面是安全且有效的。
