Plaksin S A, Farshatova L I
Vagner Perm State Medical University, Perm, Russia.
Khirurgiia (Mosk). 2021(1):22-26. doi: 10.17116/hirurgia202101122.
To compare the efficacy of chemical pleurodesis with talc and trichloroacetic acid during thoracoscopy.
Thoracoscopy with pleural biopsy was performed in 355 (83.5%) out of 424 patients with pleural effusion. Pleurodesis was ensured by intraoperative insufflation of talc powder (=135) and application of 33% trichloroacetic acid solution to parietal and visceral pleura (=19) in patients with malignant (125), inflammatory (6), post-traumatic (4), tuberculous (3), pancreatogenic (8) and hepatogenic (8) effusions. Drainage tubes were removed if daily drainage output volume was less than 100 ml or complete lung inflation was observed.
Post-pleurodesis drainage took 7.1±5.4 days. Two patients developed bumpy rashes that were initially interpreted as carcinomatosis. However, these rashes were later identified as tuberculosis. Retrospectively, these patients were not good candidates for pleurodesis. Pleurodesis with talc suppressed exudation in 89.6% of cases. Complications developed in 4 cases (3%): pneumonia (1) and pleural empyema (3). These complications were associated with a violation of technical procedure of pleurodesis, i.e. procedure in rigid lung, atelectasis (1) and bronchopleural fistula (2). Mean duration of drainage after trichloroacetic acid-induced pleurodesis was 7.9±6.7 days. This procedure was effective in 84.2% of cases, and there were no complications. There are no previous reports on the use of this pleurodesis technique in the literature. Mean duration of drainage after talc-induced pleurodesis was decreased up to 6.9±5.4 days in patients with malignant pleural effusion (<0.05), after trichloroacetic acid-induced pleurodesis - up to 7.5±8.1 days (>0.05) compared to patients without pleurodesis (9.1±11.2 days).
Pleurodesis with talc or trichloroacetic acid during thoracoscopy is effective for pleural effusions following malignancies, liver, kidney and cardiac diseases with decompensation. Essential requirements are adequate lung inflation, no atelectasis and bronchopleural fistula.
比较胸腔镜检查时使用滑石粉和三氯乙酸进行化学性胸膜固定术的疗效。
424例胸腔积液患者中，355例（83.5%）接受了胸腔镜检查及胸膜活检。对于恶性（125例）、炎症性（6例）、创伤后（4例）、结核性（3例）、胰腺源性（8例）和肝源性（8例）胸腔积液患者，通过术中吹入滑石粉（=135例）以及向壁层和脏层胸膜涂抹33%三氯乙酸溶液（=19例）来确保胸膜固定术。若每日引流量少于100 ml或观察到肺完全复张，则拔除引流管。
胸膜固定术后引流时间为7.1±5.4天。2例患者出现皮疹，最初被误诊为癌转移。然而，这些皮疹后来被确诊为结核病。回顾来看，这些患者并非胸膜固定术的合适人选。滑石粉胸膜固定术在89.6%的病例中抑制了渗出。4例（3%）出现并发症：肺炎（1例）和胸膜脓胸（3例）。这些并发症与胸膜固定术的技术操作失误有关，即硬肺、肺不张（1例）和支气管胸膜瘘（2例）情况下的操作。三氯乙酸诱导的胸膜固定术后平均引流时间为7.9±6.7天。该方法在84.2%的病例中有效，且无并发症。文献中此前尚无关于使用这种胸膜固定术技术的报道。与未进行胸膜固定术的患者（9.1±11.2天）相比，恶性胸腔积液患者滑石粉诱导的胸膜固定术后平均引流时间缩短至6.9±5.4天（<0.05），三氯乙酸诱导的胸膜固定术后平均引流时间缩短至7.5±8.1天（>0.05）。
胸腔镜检查时使用滑石粉或三氯乙酸进行胸膜固定术对恶性肿瘤、肝、肾和心脏疾病失代偿后的胸腔积液有效。基本要求是肺充分复张、无肺不张和支气管胸膜瘘。
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