Fenton K N, Richardson J D
Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
Am J Surg. 1995 Jul;170(1):69-74. doi: 10.1016/s0002-9610(99)80257-8.
Approximately half of all patients with metastatic cancer develop malignant pleural effusions. Because the patients are already terminally ill, these effusions can present significant diagnostic and therapeutic challenges. Symptoms are either present at the time of diagnosis or develop subsequently in virtually all cases. The diagnosis is based on chest radiography followed by thoracentesis or thoracoscopy. Most malignant effusions are exudative and about one third are bloody. Cytology is positive for cancer cells in the initial pleural fluid specimens from 60% of patients who are ultimately shown to have malignant effusions. The remaining 40% require a repeat thoracentesis, pleural biopsy, thoracoscopy, or multiple procedures to prove the presence of cancer. Because the average life expectancy of a patient with a malignant pleural effusion is about 6 months, it is important to obtain a diagnosis expeditiously and formulate a treatment plan that optimizes quality of life. Tube thoracostomy with chemical pleurodesis using doxycycline or bleomycin is the mainstay of current treatment and is about 85% effective.
大约一半的转移性癌症患者会出现恶性胸腔积液。由于这些患者已处于晚期，这些积液会带来重大的诊断和治疗挑战。几乎在所有病例中，症状要么在诊断时就已出现，要么随后才会出现。诊断基于胸部X光检查，随后进行胸腔穿刺或胸腔镜检查。大多数恶性积液是渗出性的，约三分之一是血性的。在最终被证明有恶性积液的患者中，60%的患者最初胸腔积液标本的癌细胞细胞学检查呈阳性。其余40%的患者需要重复胸腔穿刺、胸膜活检、胸腔镜检查或多种检查来证实癌症的存在。由于恶性胸腔积液患者的平均预期寿命约为6个月，因此迅速做出诊断并制定优化生活质量的治疗方案非常重要。使用强力霉素或博来霉素进行化学性胸膜固定术的胸腔闭式引流术是目前治疗的主要方法，有效率约为85%。
