Reinoso Jean, Aftab Ghulam, Vijayan Karthik, Mehta Hiren J
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
J Thorac Dis. 2023 May 30;15(5):2469-2474. doi: 10.21037/jtd-22-1517. Epub 2023 Mar 27.
Malignant and nonmalignant pleural effusions (NMPEs) such as those due to hepatic hydrothorax have been successfully treated with an indwelling pleural catheter (IPC) with a low complication rate. There is no literature on the utility or safety of this treatment modality for NMPE post lung resection. We aimed to assess the utility of IPC for recurrent symptomatic NMPE secondary to post lung resection in lung cancer patients over a period of 4 years.
Patients who underwent lobectomy or segmentectomy as part of the treatment plan for lung cancer between January 2019 and June 2022 were identified, these patients were screened for post-surgical pleural effusion. A total of 422 underwent lung resection, of which 12 had recurrent symptomatic pleural effusions requiring IPC placement and were selected for final analysis. The primary end points were improved symptomatology and successful pleurodesis.
Mean time to IPC placement was 78.4 days post-surgery. The mean length of IPC catheter was 77.7 days standard deviation (SD) 23.8. All 12 patients achieved spontaneous pleurodesis (SP), there was no second pleural intervention or re-accumulation of fluid on follow up imaging in any of the subjects after IPC removal. Two patients (16.7%) had skin infection related to catheter placement that was managed with oral antibiotics, there were no cases of pleural infections that required catheter removal.
IPC is a safe and effective alternative in managing recurrent NMPE post lung cancer surgery with high rate of pleurodesis and acceptable complication rates.
恶性和非恶性胸腔积液（NMPEs），如肝性胸水所致的胸腔积液，已通过留置胸腔导管（IPC）成功治疗，并发症发生率较低。目前尚无关于这种治疗方式对肺切除术后NMPEs的效用或安全性的文献。我们旨在评估IPC在4年期间对肺癌患者肺切除术后复发性有症状NMPEs的效用。
确定2019年1月至2022年6月期间作为肺癌治疗计划一部分接受肺叶切除术或肺段切除术的患者，对这些患者进行术后胸腔积液筛查。共有422例患者接受了肺切除术，其中12例有复发性有症状胸腔积液，需要放置IPC，并被选入最终分析。主要终点是症状改善和成功的胸膜固定术。
IPC放置的平均时间为术后78.4天。IPC导管的平均长度为77.7天，标准差（SD）为23.8。所有12例患者均实现了自发性胸膜固定术（SP），在移除IPC后，随访影像学检查中没有任何受试者出现第二次胸膜干预或液体再次积聚。2例患者（16.7%）发生了与导管放置相关的皮肤感染，通过口服抗生素进行了处理，没有需要移除导管的胸膜感染病例。
IPC是管理肺癌手术后复发性NMPEs的一种安全有效的替代方法，胸膜固定术发生率高，并发症发生率可接受。
