Labbé C, Tremblay L, Lacasse Y
Centre de recherche, Centre de pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC.
Curr Oncol. 2015 Dec;22(6):412-6. doi: 10.3747/co.22.2698.
Treatment of malignant pericardial effusion remains controversial, because no randomized controlled trials have been conducted to determine the best approach, and results of retrospective studies have been inconsistent. The objective of the present study was to compare pericardiocentesis and pericardiotomy with respect to efficacy for preventing recurrence, and to determine, for those two procedures, diagnostic yields, complication rates, and effects on survival. We also aimed to identify clinical and procedural factors that could predict effusion recurrence.
We retrospectively assessed 61 patients who underwent a procedure for treatment of a malignant pericardial effusion at the Institut universitaire de cardiologie et de pneumologie de Québec between February 2004 and September 2013.
Pericardiocentesis was performed in 42 patients, and pericardiotomy, in 19 patients. The effusion recurrence rate was significantly higher in patients treated with pericardiocentesis than with pericardiotomy (31.0% vs. 5.3%, p = 0.046). The diagnostic yield of the procedures was not significantly different (92.9% vs. 86.7%, p = 0.6). The overall rate of complications was similar in the two groups, as was the median overall survival (2.4 months vs. 2.6 months, p = 0.5). In univariate analyses, the procedure type was the only predictor of recurrence that approached statistical significance. Age, sex, type of cancer, presence of effusion at the time of cancer diagnosis, prior chest irradiation, tamponade upon presentation, and total volume of fluid removed did not influence the recurrence rate.
Compared with pericardiocentesis, pericardiotomy had higher success rate in preventing recurrence of malignant pericardial effusion, with similar diagnostic yields, complication rates, and overall survival.
恶性心包积液的治疗仍存在争议，因为尚无随机对照试验来确定最佳治疗方法，且回顾性研究结果并不一致。本研究的目的是比较心包穿刺术和心包切开术在预防复发方面的疗效，并确定这两种手术的诊断率、并发症发生率及对生存的影响。我们还旨在识别可预测积液复发的临床和手术因素。
我们回顾性评估了2004年2月至2013年9月期间在魁北克大学心脏病学和肺病学研究所接受恶性心包积液治疗手术的61例患者。
42例患者接受了心包穿刺术，19例患者接受了心包切开术。心包穿刺术治疗的患者积液复发率显著高于心包切开术治疗的患者（31.0%对5.3%，p = 0.046）。两种手术的诊断率无显著差异（92.9%对86.7%，p = 0.6）。两组的总体并发症发生率相似，中位总生存期也相似（2.4个月对2.6个月，p = 0.5）。在单因素分析中，手术类型是唯一接近统计学意义的复发预测因素。年龄、性别、癌症类型、癌症诊断时是否存在积液、既往胸部放疗史、就诊时是否存在心包填塞以及抽出的液体总量均不影响复发率。
与心包穿刺术相比，心包切开术在预防恶性心包积液复发方面成功率更高，诊断率、并发症发生率及总生存期相似。
