Goff B A, Mueller P R, Muntz H G, Rice L W
Vincent Memorial Gynecologic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston.
Obstet Gynecol. 1993 Jun;81(6):993-6.
To review our experience with bleomycin sclerotherapy as treatment of pleural effusions due to gynecologic malignancies.
Twenty-one women with histologically documented malignant effusions (16 ovarian carcinoma, three uterine sarcoma, and two cervical cancer) were treated with small flexible chest-tube drainage followed by intrapleural bleomycin sclerotherapy (60 units).
After placement of the chest tube, suction was required for a median of 5 days (range 3-12) before output was low enough (less than 100 mL/24 hours) to instill bleomycin. Among 24 treated effusions, there was a 71% overall response rate, including ten complete responses (42%) and seven partial responses (29%); seven effusions (29%) did not respond to therapy. Six of the seven patients whose effusions did not respond to bleomycin died of disease within 2 months of attempted sclerotherapy. Fever was the most common side effect, occurring in 13 of 21 patients (62%) following instillation of bleomycin. Pain during sclerosis was reported by only two patients.
Bleomycin sclerotherapy after small flexible chest-tube drainage of malignant pleural effusions is an effective technique, with minimal adverse reactions, for controlling effusions that develop in women with gynecologic malignancies.
回顾我们使用博来霉素硬化疗法治疗妇科恶性肿瘤所致胸腔积液的经验。
21例经组织学证实为恶性胸腔积液的女性患者（16例卵巢癌、3例子宫肉瘤和2例宫颈癌），先采用细软胸管引流，随后行胸腔内注射博来霉素硬化治疗（60单位）。
放置胸管后，在胸腔引流量足够低（低于100 mL/24小时）以便注入博来霉素之前，平均需要持续吸引5天（范围3 - 12天）。在24例接受治疗的胸腔积液中，总体有效率为71%，包括10例完全缓解（42%）和7例部分缓解（29%）；7例胸腔积液（29%）对治疗无反应。7例胸腔积液对博来霉素无反应的患者中，有6例在尝试硬化治疗后2个月内死于疾病。发热是最常见的副作用，21例患者中有13例（62%）在注入博来霉素后出现发热。只有2例患者报告了硬化治疗期间的疼痛。
对于妇科恶性肿瘤女性患者出现的胸腔积液，在采用细软胸管引流后行博来霉素硬化治疗是一种有效的技术，不良反应极少，可有效控制胸腔积液。
