Scarci Marco, Caruana Edward, Bertolaccini Luca, Bedetti Benedetta, Brunelli Alessandro, Varela Gonzalo, Papagiannopoulos Kostas, Kuzdzal Jaroslaw, Massard Gilbert, Ruffini Enrico, Falcoz Pierre Emmanuel, Opitz Isabelle, Batirel Hasan, Toker Alper, Rocco Gaetano
Department of Thoracic Surgery, University College London Hospitals, London, United Kingdom.
Department of Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Interact Cardiovasc Thorac Surg. 2017 Mar 1;24(3):414-417. doi: 10.1093/icvts/ivw373.
Malignant pleural effusion (MPE) commonly complicates advanced malignancy and their exact management is still undefined. We undertook a survey to determine the current practice among members of the European Society of Thoracic Surgeons (ESTS).
A cross-sectional survey focused on the current practice of management of MPE was developed by the authors. The questions were outlined after a review of the literature and circulated in an Internet-based survey format.
Computed tomography (125, 92%) and chest X-ray (106, 78%) are the most common imaging modalities performed in the initial evaluation. Video-assisted thoracoscopic surgery for washout and pleurodesis (93, 68%) was reported as the preferred approach to patients with uncomplicated MPE. Sixty-one (45%) of the responding colleagues routinely use large bore chest tubes for draining malignant effusions. Forty-nine (35%) surgeons would not apply suction to the drainage system, whilst 50 (37%) would use -2 kPa or less. Talc (124, 91%) is the most commonly used sclerosing agent for pleurodesis in the context of malignant pleural effusion. The practice of 76 (56%) of the respondents is not informed by any clinical guidelines, whilst 60 (44%) reported adhering to the 2010 British Thoracic Society Pleural Disease Guideline. Seventy-one (52%) declared that the guidance was in need of updating or revision.
This survey demonstrates the lacking adoption of the existing clinical guidance in this field, as well as the need for more contemporary guidelines for a better-informed practice. The ESTS Working Group on the management of MPE has been established for this purpose.
恶性胸腔积液（MPE）常使晚期恶性肿瘤病情复杂化，其确切的治疗方法仍不明确。我们开展了一项调查，以确定欧洲胸外科医师协会（ESTS）成员目前的治疗方法。
作者开展了一项横断面调查，重点关注MPE的当前治疗方法。在查阅文献后拟定问题，并以基于互联网的调查形式进行传播。
计算机断层扫描（125例，92%）和胸部X线检查（106例，78%）是初始评估中最常用的影像学检查方式。对于无并发症的MPE患者，电视辅助胸腔镜手术冲洗和胸膜固定术（93例，68%）被报告为首选方法。61位（45%）做出回应的同事常规使用大口径胸管引流恶性胸腔积液。49位（35%）外科医生不会对引流系统施加负压，而50位（37%）会使用-2kPa或更低的负压。滑石粉（124例，91%）是恶性胸腔积液情况下胸膜固定术中最常用的硬化剂。76位（56%）受访者的治疗方法未参考任何临床指南，而60位（44%）报告遵循2010年英国胸科学会胸膜疾病指南。71位（52%）宣称该指南需要更新或修订。
本次调查表明该领域现有临床指南的采用情况不足，以及需要更新的指南以实现更明智的治疗。为此已成立了ESTS MPE治疗工作组。
