Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Internal Medicine, Instituto Tecnologico y de Estudios Superiores de Monterrey, Monterrey, Mexico.
J Bronchology Interv Pulmonol. 2024 Apr 1;31(2):155-159. doi: 10.1097/LBR.0000000000000956.
Pleural infections related to indwelling pleural catheters (IPCs) are an uncommon clinical problem. However, management decisions can be complex for patients with active malignancies due to their comorbidities and limited life expectancies. There are limited studies on the management of IPC-related infections, including whether to remove the IPC or use intrapleural fibrinolytics.
We conducted a retrospective cohort study of patients with active malignancies and IPC-related empyemas at our institution between January 1, 2005 and May 31, 2021. The primary outcome was to evaluate clinical outcomes in patients with malignant pleural effusions and IPC-related empyemas treated with intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) compared with those treated with tPA alone or no intrapleural fibrinolytic therapy. The secondary outcome evaluated was the incidence of bleeding complications.
We identified 69 patients with a malignant pleural effusion and an IPC-related empyema. Twenty patients received tPA/DNase, 9 received tPA alone, and 40 were managed without fibrinolytics. Those treated with fibrinolytics were more likely to have their IPCs removed as part of the initial management strategy ( P =0.004). The rate of surgical intervention and mortality attributable to the empyema were not significantly different between treatment groups. There were no bleeding events in any group.
In patients with IPC-related empyemas, we did not find significant differences in the rates of surgical intervention, empyema-related mortality, or bleeding complications in those treated with intrapleural tPA/DNase, tPA alone, or no fibrinolytics. More patients who received intrapleural fibrinolytics had their IPCs removed, which may have been due to selection bias.
与留置性胸膜导管（IPC）相关的胸膜感染是一种罕见的临床问题。然而，由于合并症和预期寿命有限，对于患有活动性恶性肿瘤的患者，管理决策可能会变得复杂。关于 IPC 相关感染的管理，包括是否移除 IPC 或使用胸膜内纤维蛋白溶解剂，研究有限。
我们对 2005 年 1 月 1 日至 2021 年 5 月 31 日期间在我院就诊的患有活动性恶性肿瘤和 IPC 相关脓胸的患者进行了回顾性队列研究。主要结局是评估在接受胸膜内组织纤溶酶原激活剂（tPA）和脱氧核糖核酸酶（DNase）治疗的恶性胸腔积液和 IPC 相关脓胸患者的临床结局，与单独接受 tPA 治疗或未接受胸膜内纤维蛋白溶解治疗的患者相比。次要结局评估了出血并发症的发生率。
我们确定了 69 例患有恶性胸腔积液和 IPC 相关脓胸的患者。20 例患者接受 tPA/DNase 治疗，9 例患者接受 tPA 单独治疗，40 例患者未接受纤维蛋白溶解治疗。接受纤维蛋白溶解治疗的患者更有可能作为初始管理策略的一部分将其 IPC 移除（P=0.004）。各组之间手术干预和脓胸相关死亡率没有显著差异。任何一组均无出血事件。
在患有 IPC 相关脓胸的患者中，我们未发现接受胸膜内 tPA/DNase、单独 tPA 或未接受纤维蛋白溶解治疗的患者的手术干预率、脓胸相关死亡率或出血并发症发生率有显著差异。接受胸膜内纤维蛋白溶解治疗的患者中，更多的患者接受了 IPC 移除，这可能是由于选择偏倚。
