Drevet Gabrielle, Maury Jean-Michel, Bakrin Naoual, Tronc François
Department of Thoracic Surgery, Lung and Heart-Lung Transplantation, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France.
Viral Infection and Comparative Pathology (IVPC), UMR 754, Claude Bernard Lyon 1 University, Lyon, France.
Pleura Peritoneum. 2020 Nov 9;5(4):20200129. doi: 10.1515/pp-2020-0129. eCollection 2020 Nov.
Malignant pleural effusion (MPE) is a devastating evolution of several malignancies. Pressurized intrathoracic aerosol chemotherapy (PITAC) might be a novel therapy option in MPE.
PITAC is considered for patients with MPE with a performance status <2 and without other metastatic sites. General anesthesia is administered and a double-lumen bronchial tube is inserted. The patient is placed in a lateral decubitus position, and the operation is performed after ipsilateral lung exclusion. Two 12-mm balloon trocars are inserted-one in the seventh intercostal space in the mid-axillary line and one in the fifth intercostal space in the anterior axillary line. Extent of pleural disease and volume of MPE are documented. MPE is removed and parietal pleural biopsy are performed. An intrathoracic pressure of 12 mmHg CO is established, and a combination of Cisplatin (10.5 mg/m in a total volume of 150 cc NaCl 0.9%) and Doxorubicin (2.1 mg/m in a total volume of 50 cc NaCl 0.9%) are aerosolized via nebulizer in the pleural cavity. Vital signs and nebulization are remote-controlled. After 30 min, the remaining toxic aerosol is exhausted using a closed surgical smoke evacuation system. A 24Fr chest tube is inserted in postero-apical position with continuous negative pressure of 20 cm HO. When needed, PITAC may be repeated every six weeks in alternate with systemic chemotherapy.
In our hands, the technique above has shown to be feasible and safe.
Further studies are needed to assess the potential symptomatic and oncological benefits of PITAC in MPE.
恶性胸腔积液（MPE）是多种恶性肿瘤的严重进展。胸腔内加压雾化化疗（PITAC）可能是MPE的一种新型治疗选择。
PITAC适用于体能状态<2且无其他转移部位的MPE患者。实施全身麻醉并插入双腔支气管导管。患者取侧卧位，在患侧肺萎陷后进行手术。插入两根12毫米的球囊套管针，一根位于腋中线第七肋间，一根位于腋前线第五肋间。记录胸膜疾病范围和MPE体积。抽出MPE并进行壁层胸膜活检。建立12 mmHg CO的胸腔内压力，将顺铂（10.5 mg/m，总量150 cc 0.9%氯化钠溶液）和阿霉素（2.1 mg/m，总量50 cc 0.9%氯化钠溶液）通过雾化器在胸腔内雾化。生命体征和雾化过程由远程控制。30分钟后，使用封闭式手术烟雾抽吸系统排出残留的有毒气雾剂。在胸腔后顶部插入一根24Fr胸管，持续负压为20 cm H₂O。必要时，PITAC可每六周与全身化疗交替重复进行。
在我们的操作中，上述技术已证明是可行且安全的。
需要进一步研究以评估PITAC在MPE中的潜在症状改善和肿瘤学益处。
