Girardi L N, Ginsberg R J, Burt M E
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Thorac Surg. 1997 Nov;64(5):1422-7; discussion 1427-8. doi: 10.1016/S0003-4975(97)00992-2.
Pericardial effusions remain a formidable problem in patients with an advanced malignancy. We reviewed our experience with pericardiocentesis and intrapericardial sclerotherapy versus open surgical drainage as the treatment for these effusions.
A retrospective review was performed of one surgeon's experience (M.E.B.) with the surgical treatment of malignant pericardial effusions at a tertiary-care cancer center.
Sixty patients underwent 72 procedures during 8 years. Thirty-seven (51%) pericardiocenteses and 35 (49%) open procedures were performed in patients with effusions. There was no significant difference in the complication rates seen between those effusions drained via pericardiocentesis (n = 5; 13%) and those drained in an open surgical procedure (n = 5; 14%). Similar results were seen with respect to the development of a recurrent effusion. There were no procedure-related deaths. The median survival for all patients was 97 days. Patients with breast cancer as their primary malignancy survived significantly longer after drainage than did all others (p = 0.01). The type of procedure did not influence survival. Costs of surgical drainage exceed those of pericardiocentesis by nearly fortyfold.
Pericardiocentesis with intrapericardial sclerotherapy is as effective as open surgical drainage for the management of malignant pericardial effusions.
心包积液在晚期恶性肿瘤患者中仍然是一个棘手的问题。我们回顾了我们在采用心包穿刺术及心包内硬化疗法与开放性手术引流治疗这些积液方面的经验。
对一位外科医生（M.E.B.）在一家三级癌症中心治疗恶性心包积液的手术经验进行了回顾性研究。
8年间60例患者接受了72次手术。对有积液的患者进行了37次（51%）心包穿刺术和35次（49%）开放性手术。经心包穿刺术引流的积液（n = 5；13%）与开放性手术引流的积液（n = 5；14%）的并发症发生率无显著差异。在复发性积液的发生方面也观察到了类似结果。没有与手术相关的死亡病例。所有患者的中位生存期为97天。以乳腺癌为主要恶性肿瘤的患者在引流后的生存期明显长于所有其他患者（p = 0.01）。手术方式不影响生存期。手术引流的费用比心包穿刺术高出近40倍。
心包穿刺术及心包内硬化疗法在治疗恶性心包积液方面与开放性手术引流同样有效。
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