Baqi Abdul, Ahmed Intisar, Shams Pirbhat
Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
J Clin Transl Res. 2023 Jun 2;9(3):206-211. eCollection 2023 Jun 29.
The clinical course of malignancies is frequently complicated by third spacing in body cavities, including pericardial effusion. What remains the optimal management for malignant pericardial effusion is a dilemma.
We aimed to compare 30-day outcomes of imaging-guided pericardiocentesis and surgical pericardial window in patients with malignant pericardial effusion.
A retrospective observational study was done at a tertiary care hospital. We reviewed hospital record files of 91 consecutive patients admitted with malignant pericardial effusion from January 2010 to December 2019 and requiring imaging-guided pericardiocentesis or pericardial window.
A total of 71 patients were included in the final analysis. Most patients were male (68%). The mean age was 45 years. Hypertension was the most common comorbid condition. Lymphoma or leukemia (39%) was the most common cause of malignant pericardial effusion followed by lung cancer (28%). About 57.7% of patients underwent pericardiocentesis, and the remainder underwent surgical pericardial window (42.3%). The overall procedural success was 97.2%, and the overall mortality was 5.6%. The success rate was similar when pericardiocentesis was compared with the surgical pericardial window ( = 0.22). The length of hospital stay was higher in patients undergoing pericardial window ( = 0.007), whereas the re-accumulation rate was higher in the pericardiocentesis group (0% versus 34%, < 0.001). Patients undergoing pericardial window had higher odds of major bleeding requiring transfusions.
There is a higher rate of recurrence following isolated pericardiocentesis but a comparable mortality difference between the two procedures. Complication rates can be reduced by improving surgical technique and peri-operative management. Meticulous surgical care, infection precautions, and good glycemic control in this immunocompromised subset can preserve the pericardial window as a better management option.
Pericardial window is a promising and effective management option for patients with recurrent malignant pericardial effusion, but it comes at the cost of bleeding and infection. More extensive trials are needed to understand better the long-term outcomes of pericardial window or pericardiocentesis in patients with malignant effusion.
恶性肿瘤的临床病程常因体腔第三间隙形成而复杂化，包括心包积液。对于恶性心包积液的最佳治疗方案仍存在争议。
我们旨在比较影像引导下心包穿刺术和外科心包开窗术治疗恶性心包积液患者的30天结局。
在一家三级医疗中心进行了一项回顾性观察研究。我们回顾了2010年1月至2019年12月期间连续收治的91例恶性心包积液患者的医院病历档案，这些患者均需要影像引导下心包穿刺术或心包开窗术。
最终纳入分析71例患者。大多数患者为男性（68%）。平均年龄为45岁。高血压是最常见的合并症。淋巴瘤或白血病（39%）是恶性心包积液最常见的病因，其次是肺癌（28%）。约57.7%的患者接受了心包穿刺术，其余患者接受了外科心包开窗术（42.3%）。总体手术成功率为97.2%，总体死亡率为5.6%。心包穿刺术与外科心包开窗术相比成功率相似（P = 0.22）。接受心包开窗术的患者住院时间更长（P = 0.007），而心包穿刺术组的再积聚率更高（0%对34%，P < 0.001）。接受心包开窗术的患者发生需要输血的大出血的几率更高。
单纯心包穿刺术后复发率较高，但两种手术的死亡率差异相当。可通过改进手术技术和围手术期管理来降低并发症发生率。在这个免疫功能低下的亚组中，精心的手术护理、感染预防措施和良好的血糖控制可使心包开窗术成为更好的治疗选择。
心包开窗术对于复发性恶性心包积液患者是一种有前景且有效的治疗选择，但会有出血和感染的风险。需要进行更广泛的试验以更好地了解心包开窗术或心包穿刺术治疗恶性积液患者的长期结局。
