Vargas F S, Milanez J R, Filomeno L T, Fernandez A, Jatene A, Light R W
Instituto do Coração, University of Sao Paulo, Brazil.
Chest. 1994 Dec;106(6):1771-5. doi: 10.1378/chest.106.6.1771.
Chemical pleurodesis has become the preferred treatment for definitive management of malignant pleural effusions. The treatment of patients with recurrent benign or undiagnosed pleural effusions, however, remains a difficult clinical problem. Tetracycline has been widely used as a sclerosing agent, but parenteral tetracycline is no longer available. Therefore, alternative sclerosing agents are needed. Talc was used for the first time in 1935, and subsequently there have been several reports documenting its effectiveness in the treatment of malignant pleural effusion and pneumothorax. The objective of this study is to present our experience with a low dose of aerosolized talc for controlling nonmalignant pleural effusions. Between May 1985 and October 1992, twenty-two patients underwent talc pleurodesis at the time of thoracoscopy for control of a nonmalignant effusion. The cause of the effusion was cirrhosis in six patients, systemic lupus erythematosus in two, chylothorax in five, and no diagnosis in nine patients. Follow-up has ranged from 18 days to 5 years. Only two patients (9 percent), one with cirrhosis and another with an undiagnosed pleural effusion, had a recurrence of the effusions. We conclude that the intrapleural administration of 2 g of aerosolized talc is an effective treatment for recurrent benign (including chylothorax) or undiagnosed pleural effusions.
化学性胸膜固定术已成为恶性胸腔积液确定性治疗的首选方法。然而，复发性良性或未确诊胸腔积液患者的治疗仍然是一个棘手的临床问题。四环素曾被广泛用作硬化剂，但注射用四环素已不再可用。因此，需要替代的硬化剂。滑石粉于1935年首次使用，随后有几份报告记录了其在治疗恶性胸腔积液和气胸方面的有效性。本研究的目的是介绍我们使用低剂量雾化滑石粉控制非恶性胸腔积液的经验。1985年5月至1992年10月期间，22例患者在胸腔镜检查时接受了滑石粉胸膜固定术以控制非恶性胸腔积液。积液原因在6例患者中为肝硬化，2例为系统性红斑狼疮，5例为乳糜胸，9例未明确诊断。随访时间为18天至5年。只有2例患者（9%）出现积液复发，1例为肝硬化患者，另1例为未确诊胸腔积液患者。我们得出结论，胸腔内注入2 g雾化滑石粉是治疗复发性良性（包括乳糜胸）或未确诊胸腔积液的有效方法。
