Department of Pulmonary, Critical Care and Sleep Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Department of Internal Medicine, Birat Medical College, Nepal.
JNMA J Nepal Med Assoc. 2021 Jan 31;59(233):69-73. doi: 10.31729/jnma.6033.
Pleurodesis is a procedure to achieve symphysis between the two layers of pleura aimed at preventing the accumulation of either air or fluid in the pleural space. In Nepal, intrapleural instillation of the chemical sclerosing agent is more commonly done as thoracoscopy facility is not easily available. However, iodopovidone is rarely used for this purpose in Nepal. The study aims to find the prevalence of success using iodopovidone as the chemical sclerosing agent.
The study included cases undergoing pleurodesis over a two-year period. The clinicodemographic data, diagnosis, treatment effect and treatment response were analyzed. The treatment response was graded as Treatment Success (Complete Response or Partial Response) and Treatment Failure.
Pleurodesis was done in a total of 54 cases. Of those, 39 cases were Secondary Spontaneous Pneumothorax, 11 were Malignant Pleural Effusion, 3 were Primary Spontaneous Pneumothorax, and 1 was a case of Hepatic Hydrothorax. Among Secondary Spontaneous Pneumothorax, Pleurodesis was successful in 37 (95%) out of 39 cases, with 35 (90%) having a Complete Response and 2 (5%) having a Partial Response while 2 (5%) had Treatment failure. Among Malignant Pleural Effusion, treatment success was achieved in 6 (55%) out of 11, whereas 5 (45%) failed the treatment. The commonest complication was burning sensation, and the commonest pain scale was "distressing."
This study highlights the safety and ease of use of iodopovidone as an agent for chemical pleurodesis. It confirms the high rate of success of pleurodesis in cases of pneumothorax as found in other studies. In contrast, the success rate is understandably lower in cases of Malignant Pleural effusion.
胸膜固定术是一种使两层胸膜融合以防止胸腔内积聚空气或液体的方法。在尼泊尔，由于胸腔镜设施不易获得，因此更常进行胸膜内化学硬化剂灌洗。然而，在尼泊尔，很少使用碘络酮作为这种用途的化学硬化剂。本研究旨在发现使用碘络酮作为化学硬化剂的成功率。
该研究包括在两年期间进行胸膜固定术的病例。分析了临床病理数据、诊断、治疗效果和治疗反应。治疗反应分为治疗成功（完全反应或部分反应）和治疗失败。
共进行了 54 例胸膜固定术。其中，39 例为继发性自发性气胸，11 例为恶性胸腔积液，3 例为原发性自发性气胸，1 例为肝性胸水。在继发性自发性气胸患者中，39 例中的 37 例（95%）胸膜固定术成功，35 例（90%）完全反应，2 例（5%）部分反应，2 例（5%）治疗失败。在恶性胸腔积液患者中，11 例中有 6 例（55%）治疗成功，而 5 例（45%）治疗失败。最常见的并发症是烧灼感，最常见的疼痛量表是“痛苦”。
本研究强调了碘络酮作为胸膜固定术化学硬化剂的安全性和易用性。它证实了胸膜固定术在气胸病例中的高成功率，与其他研究结果一致。相比之下，在恶性胸腔积液病例中，成功率较低是可以理解的。
