Tomkowski W, Szturmowicz M, Borowiec B, Burakowski J, Fijałkowska A, Kober J, Filipecki S
Kliniki Chorób Wewnetrznych Instytutu Gruźlicy i Chorób Płuc w Warszawie.
Pneumonol Alergol Pol. 1996;64 Suppl 2:180-6.
30 consecutive patients with large malignant pericardial effusion (MPE) entered this prospective study. After pericardiocentesis and insertion of a polyurethane catheter, pericardial fluid was drained. Malignant etiology of pericardial fluid was confirmed by cytological examination. After confirmation of MPE cisplatin (10 mg in 20 ml normal saline) was instilled over 5 minutes during 5 consecutive days directly into pericardial space. If fluid reaccumulation occurred the courses were repeated every 3 weeks. Treatment was considered successful if the patient with malignant effusion survived 30 days without recurrence of symptoms of large pericardial effusion and other interventions directed to the pericardium were required. Positive effect of intrapericardial treatment with cisplatin was achieved in 18 cases (60%). Mean period of response was 3, 7 months (+/-6). Cisplatin administered directly into pericardial space is effective and safe method of treatment of recurrent MPE. Sclerosis of the pericardial space is rare complication connected with CP. Positive effect of CP can depend on improvement of lymphatic drainage from heart. CP seems to be method of choice in intal intrapericardial treatment in patients with malignant cardiac tamponade and recurrent MPE in course of lung cancer.
30例连续性大量恶性心包积液(MPE)患者进入了这项前瞻性研究。在进行心包穿刺并插入聚氨酯导管后,引流心包积液。通过细胞学检查确认心包积液的恶性病因。在确认MPE后,连续5天每天在5分钟内将顺铂(10毫克溶于20毫升生理盐水中)直接注入心包腔。如果积液再次积聚,每3周重复疗程。如果恶性积液患者存活30天且无大量心包积液症状复发且无需针对心包的其他干预措施,则认为治疗成功。18例(60%)患者心包内注射顺铂取得了积极效果。平均缓解期为3.7个月(±6)。直接注入心包腔的顺铂是治疗复发性MPE的有效且安全的方法。心包腔硬化是与顺铂相关的罕见并发症。顺铂的积极效果可能取决于心脏淋巴引流的改善。对于患有恶性心脏压塞和肺癌病程中复发性MPE的患者,顺铂似乎是心包内初始治疗的首选方法。