Westley Richard, De Fonseka Duneesha, Bedawi Eihab O
Department of Respiratory Medicine, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Department of Infection, Immunity and Cardiovascular Disease, School of Medicine & Population Health, University of Sheffield, Sheffield, UK.
J Thorac Dis. 2025 Aug 31;17(8):6283-6295. doi: 10.21037/jtd-2025-113. Epub 2025 Jul 28.
The presence of a malignant pleural effusion (MPE) confers a poor prognosis, with a high burden of disabling symptoms due to altered respiratory mechanics and abnormal diaphragm function. Management is often palliative in nature, with the emphasis on preventing fluid re-accumulation. In the era of targeted therapies, pleural biopsies are often required for gene expression and receptor status profiling, for which local anaesthetic thoracoscopy provides the highest diagnostic yield. Interventions to achieve symptom control include thoracentesis, chest drain insertion, indwelling pleural catheters, medical thoracoscopy and surgery. The evidence base for these interventions has historically been lacking with a somewhat linear pathway, however, numerous well-designed, multicentre randomised controlled trials over the last decade using patient-centred outcomes have informed recent clinical practice guidelines. Several therapeutic options and combinations now exist to achieve optimal symptom control and pleurodesis, centred around patient choice and priorities, inpatient versus outpatient strategies and the presence of non-expandable lung. This review will explore the data that has shaped MPE management in the last decade, with the aim of providing a deeper understanding of the rationale behind current international guideline recommendations. It will also highlight areas where the evidence base is lacking, research currently in progress and potential future directions.
恶性胸腔积液（MPE）的存在预示着预后不良，由于呼吸力学改变和膈肌功能异常，会带来严重的致残症状负担。治疗通常以姑息治疗为主，重点是防止液体再次积聚。在靶向治疗时代，胸膜活检常常用于基因表达和受体状态分析，局部麻醉胸腔镜检查在这方面的诊断阳性率最高。实现症状控制的干预措施包括胸腔穿刺术、胸腔引流管置入、留置胸膜导管、内科胸腔镜检查和手术。过去，这些干预措施的循证依据一直不足，且路径较为单一，然而，在过去十年中，多项精心设计的多中心随机对照试验以患者为中心的结局指标为近期临床实践指南提供了依据。现在有几种治疗选择和联合方案，围绕患者选择和优先事项、住院与门诊策略以及肺不可扩张的情况，以实现最佳症状控制和胸膜固定术。本综述将探讨过去十年中影响MPE治疗的相关数据，旨在更深入地理解当前国际指南建议背后的原理。它还将突出循证依据不足的领域、目前正在进行的研究以及潜在的未来方向。
