Swanepoel E, Apffelstaedt J P
Department of Surgery, University of Stellenbosch, Cape Town, South Africa.
J Surg Oncol. 1997 Apr;64(4):308-11. doi: 10.1002/(sici)1096-9098(199704)64:4<308::aid-jso11>3.0.co;2-z.
Few data are available on malignant pericardial effusion (MPCE) in breast cancer. We identify the patient prone to develop MPCE describe the result of surgical management, and try to identify a subgroup of patients who do not benefit from surgical management.
We performed an audit of our policy of active search for MPCE in breast cancer patients and its treatment by subxiphoid pericardial fenestration.
Nineteen patients with MPCE had a mean of 3.2 other sites of recurrence: 17 had pleural recurrence. Six patients had exertional dyspnea and 13 had dyspnea at rest; three needed emergency pericardiocentesis. An average of 740 ml of fluid was recovered; cytology was diagnostic in 11 cases and histopathology in 10 cases. At discharge, six patients had no dyspnea and six had exertional dyspnea. Of 10 patients who did not receive systemic treatment, eight died within 30 days. Nine patients who received systemic treatment had an average survival of 8.3 months.
Patients with pleural recurrence presenting with dyspnea should be evaluated for the presence of a MPCE. Subxiphoid pericardial fenestration is the treatment of choice. Patients who will not receive systemic treatment should be managed conservatively.
关于乳腺癌患者恶性心包积液（MPCE）的数据很少。我们确定易发生MPCE的患者，描述手术治疗的结果，并试图确定一组无法从手术治疗中获益的患者亚组。
我们对乳腺癌患者中积极筛查MPCE及其通过剑突下心包开窗术治疗的策略进行了审核。
19例MPCE患者平均有3.2个其他复发部位：17例有胸膜复发。6例患者有劳力性呼吸困难，13例有静息时呼吸困难；3例需要紧急心包穿刺术。平均抽出740毫升液体；11例细胞学诊断阳性，10例组织病理学诊断阳性。出院时，6例患者无呼吸困难，6例有劳力性呼吸困难。10例未接受全身治疗的患者中，8例在30天内死亡。9例接受全身治疗的患者平均生存期为8.3个月。
有胸膜复发且出现呼吸困难的患者应评估是否存在MPCE。剑突下心包开窗术是首选治疗方法。不接受全身治疗的患者应采取保守治疗。
