Iqbal Beenish, Bedawi Eihab, Rahman Najib M
Oxford Respiratory Trials Unit, Nuffield Department of Medicine, University of Oxford, Oxford UK.
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Breathe (Sheff). 2024 Nov 12;20(3):240034. doi: 10.1183/20734735.0034-2024. eCollection 2024 Oct.
Malignant pleural effusions (MPE) tend to recur and require definitive treatment with either chest drain and talc pleurodesis or indwelling pleural catheters (IPCs), which offer similar symptomatic benefits. In recent years, IPCs have become popular due to the presumed convenience of an outpatient procedure followed by home drainage leading to a misconception of IPCs being an ideal treatment for MPE. However, IPCs predispose the patient to multiple complications and have significant physical and psychological implications that are under-recognised. Patients require additional clinical reviews, hospital admissions and treatment for these complications related to IPCs. Additionally, there is a huge psychological impact of living with a home catheter that is a constant reminder of their cancer and this has been shown to affect quality of life negatively. Hence, IPCs should not be considered the "ideal" treatment for MPE management and clinicians should reflect the equipoise of the evidence for the benefits and accurately reflect the adverse effects of IPCs in their discussions with patients to facilitate informed decision making.
恶性胸腔积液（MPE）往往会复发，需要通过胸腔引流加滑石粉胸膜固定术或留置胸膜导管（IPC）进行确定性治疗，这两种方法在缓解症状方面效果相似。近年来，由于IPC被认为是一种门诊手术，随后可在家中进行引流，较为方便，因此受到欢迎，这导致人们误解其为MPE的理想治疗方法。然而，IPC会使患者易发生多种并发症，并且对身体和心理有重大影响，而这些影响尚未得到充分认识。患者需要针对与IPC相关的这些并发症进行额外的临床检查、住院治疗。此外，在家中使用导管生活对心理有巨大影响，这会不断提醒患者自己患有癌症，并且已证明会对生活质量产生负面影响。因此，IPC不应被视为MPE管理的“理想”治疗方法，临床医生应在与患者的讨论中权衡支持其益处的证据，并准确反映IPC的不良反应，以促进明智的决策。
