Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital, PO Box 241, Cape Town, 8000, South Africa.
Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
Ther Adv Respir Dis. 2018 Jan-Dec;12:1753466618785098. doi: 10.1177/1753466618785098.
Malignant pleural effusion (MPE) affects more than 1 million people globally. There is a dearth of evidence on the therapeutic approach to MPE, and not surprisingly a high degree of variability in the management thereof. We aimed to provide practicing clinicians with an overview of the current evidence on the management of MPE, preferentially focusing on studies that report patient-related outcomes rather than pleurodesis alone, and to provide guidance on how to approach individual cases. A pleural intervention for MPE will perforce be palliative in nature. A therapeutic thoracentesis provides immediate relief for most. It can be repeated, especially in patients with a slow rate of recurrence and a short anticipated survival. Definitive interventions, individualized according the patient's wishes, performance status, prognosis and other considerations (including the ability of the lung to expand) should be offered to the remainder of patients. Chemical pleurodesis (achieved via intercostal drain or pleuroscopy) and indwelling pleural catheter (IPC) have equal impact on patient-based outcomes, although patients treated with IPC spend less time in hospital and have less need for repeat pleural drainage interventions. Talc slurry via IPC is an attractive recently validated option for patients who do not have a nonexpandable lung.
恶性胸腔积液（MPE）影响着全球超过 100 万人。目前针对 MPE 的治疗方法的证据不足，管理方法也存在很大差异，这并不奇怪。我们的目的是为临床医生提供 MPE 管理方面的最新证据概述，优先关注报告患者相关结局的研究，而不仅仅是单纯的胸膜固定术，并就如何处理个别病例提供指导。针对 MPE 的胸膜介入治疗必然是姑息性的。大多数情况下，治疗性胸腔穿刺术可立即缓解症状。对于复发率较慢且预期生存时间较短的患者，可以重复进行胸腔穿刺术。应根据患者的意愿、身体状况、预后和其他因素（包括肺扩张能力），为其余患者提供个体化的确定性干预措施。化学性胸膜固定术（通过肋间引流或胸腔镜实现）和留置胸腔导管（IPC）对基于患者的结局具有同等影响，尽管接受 IPC 治疗的患者在医院的住院时间更短，需要重复胸腔引流干预的次数也更少。对于没有可扩张肺的患者，通过 IPC 注入滑石粉混悬液是一种最近得到验证的有吸引力的选择。
