Lovato Jean-Baptiste, Laroumagne Sophie, Tronchetti Julie, Nguyen Ngoc Anh Thu, Dutau Hervé, Astoul Philippe
Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France.
Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France.
Respir Med Res. 2024 Nov;86:101124. doi: 10.1016/j.resmer.2024.101124. Epub 2024 Jun 22.
Malignant pleural effusions (MPE) are a frequent and major turning point in neoplastic disease usually leading to poor life expectancy. Improve quality of life and relieve the dyspnea are the main objectives in this palliative care setting. This can be achieved by the placement of an indwelling catheter (IPC) or talc pleurodesis ideally performed by thoracoscopy route (talc poudrage). Beside to misidentify a trapped-lung, the latter requires a prolonged hospital stay and the IPC placement does not allow a high pleurodesis rate. To overcome these drawbacks, a combination of both technique could be proposed for the management of recurrent malignant pleural effusions. Safety and efficacy of this pragmatic approach are reported.
Consecutive patients who have been managed for recurrent MPE by a combination of talc poudrage for pleural symphysis by thoracoscopy route ending with the insertion of IPC using the same thoracic point of entry. Demographic data, hospital length of stay (LOS), procedural-related complications, patients' quality of life (QoL) and success of pleurodesis were collected. Patients were followed-up for 6 months.
The data of twenty-five consecutive patients undergoing the procedure were analyzed. Successful pleurodesis was obtained for 14/25 patients (66 %) at one month, 17/20 patients (85 %) at 3 months and 13/15 patients (86 %) at 6 months respectively. On average, the hospital LOS after the procedure was 3.24 days (IQR 1-4) with a median of 1 day. A prolonged hospitalization (>1 day) was never due to the procedure except for one patient (pneumothorax). No IPC related infection or procedure related deaths were noted.
Among patients with recurrent MPE, the combination of talc poudrage symphysis by thoracoscopy route and IPC placement on the same time results in a shortened hospital LOS and higher rate of pleurodesis. Further randomized clinical trials are needed to confirm these results.
恶性胸腔积液（MPE）是肿瘤疾病中常见且重要的转折点，通常会导致预期寿命缩短。改善生活质量和缓解呼吸困难是这种姑息治疗的主要目标。这可以通过置入留置导管（IPC）或滑石粉胸膜固定术来实现，理想情况下滑石粉胸膜固定术通过胸腔镜途径（滑石粉喷洒）进行。除了误判肺陷闭外，后者需要较长的住院时间，而IPC置入术无法实现高胸膜固定率。为克服这些缺点，可提出将两种技术联合用于复发性恶性胸腔积液的治疗。本文报道了这种实用方法的安全性和有效性。
连续纳入通过胸腔镜途径进行滑石粉喷洒以实现胸膜粘连，最后在相同胸壁穿刺点置入IPC来治疗复发性MPE的患者。收集人口统计学数据、住院时间（LOS）、与手术相关的并发症、患者生活质量（QoL）和胸膜固定术的成功率。对患者进行6个月的随访。
分析了连续25例接受该手术患者的数据。分别在1个月时，14/25例患者（66%）成功实现胸膜固定；3个月时，17/20例患者（85%）成功；6个月时，13/15例患者（86%）成功。术后平均住院时间为3.24天（四分位数间距1 - 4），中位数为1天。除1例患者（气胸）外，延长住院时间（>1天）从未由手术导致。未发现与IPC相关的感染或与手术相关的死亡。
在复发性MPE患者中，胸腔镜途径滑石粉粘连术与IPC同期置入可缩短住院时间并提高胸膜固定率。需要进一步的随机临床试验来证实这些结果。
