留置胸膜导管在血液恶性肿瘤患者中的应用：一项 14 年的单中心经验。
Indwelling Pleural Catheters for Patients with Hematologic Malignancies. A 14-Year, Single-Center Experience.
机构信息
1 Department of Pulmonary Medicine, and.
2 Division of Pulmonary, Critical Care Medicine, and Sleep Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.
出版信息
Ann Am Thorac Soc. 2017 Jun;14(6):976-985. doi: 10.1513/AnnalsATS.201610-785OC.
RATIONALE
Placement of an indwelling pleural catheter is an established modality for symptom relief and pleurodesis in the treatment of malignant pleural effusion. Concerns remain regarding possible infectious complications, risk of hemorrhage, and the rate of pleurodesis with the use of pleural catheters in the treatment of hematologic malignancies.
OBJECTIVES
The goals of our study were: (1) to evaluate the safety and cumulative incidence of pleurodesis with indwelling pleural catheters for patients with hematologic malignancies, and (2) to evaluate overall survival of this cohort of patients with pleural effusions.
METHODS
We performed a retrospective review of 172 patients with a hematologic malignancy who underwent placement of an indwelling pleural catheter between September 1997 and August 2011 at the University of Texas MD Anderson Cancer Center in Houston, Texas. A competing risk model analysis was used for complications and pleurodesis. Analysis was based on each patient's first intrapleural catheter.
RESULTS
There were 172 patients with lymphoma (58%), acute (16%) or chronic leukemia (16%), or multiple myeloma (10%). The effusions were characterized as malignant (85.5%), infectious (4.1%), volume overload (4.7%), or therapy-related (4.7%). Chylothorax was found in 20.1%. Pleural biopsies were obtained from 13 patients. The cumulative incidence of all complications was 13.6%, and the cumulative incidence of all significant catheter-related complications was 9.5%. The incidence of empyema was 2.9%, and major bleeding (requiring transfusion or intervention) was 1.7%. Thirty-day procedure-associated mortality was 0.6%. The cumulative incidence of pleurodesis at 180 days was 50%, with a median time to pleurodesis of 81 days for the entire cohort.
CONCLUSIONS
Indwelling pleural catheters appear to be safe for patients with hematologic malignancies. Complications and the cumulative incidence of pleurodesis are comparable to those reported for patients with solid organ malignancies.
原理
留置胸腔导管是治疗恶性胸腔积液缓解症状和胸膜固定的一种成熟方法。在血液病患者中使用胸腔导管治疗时，人们仍然对可能发生的感染并发症、出血风险以及胸膜固定的成功率存在担忧。
目的
我们的研究目的是：（1）评估留置胸腔导管治疗血液病患者的安全性和胸膜固定的累积发生率；（2）评估该胸腔积液患者队列的总生存率。
方法
我们对 1997 年 9 月至 2011 年 8 月期间在德克萨斯大学 MD 安德森癌症中心接受留置胸腔导管的 172 例血液病患者进行了回顾性研究。采用竞争风险模型分析并发症和胸膜固定情况。分析基于每位患者的第一根胸腔内导管。
结果
患者包括淋巴瘤（58%）、急性（16%）或慢性白血病（16%）或多发性骨髓瘤（10%）。胸腔积液特征为恶性（85.5%）、感染（4.1%）、容量超负荷（4.7%）或治疗相关（4.7%）。乳糜胸发生率为 20.1%。13 例患者进行了胸腔活检。所有并发症的累积发生率为 13.6%，所有显著与导管相关的并发症的累积发生率为 9.5%。脓胸发生率为 2.9%，大出血（需要输血或介入治疗）发生率为 1.7%。30 天手术相关死亡率为 0.6%。整个队列的胸膜固定累积发生率在 180 天时为 50%，中位时间为 81 天。
结论
留置胸腔导管似乎对血液病患者是安全的。并发症和胸膜固定的累积发生率与实体器官恶性肿瘤患者报道的相似。
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