Patz E F, McAdams H P, Erasmus J J, Goodman P C, Culhane D K, Gilkeson R C, Herndon J
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
Chest. 1998 May;113(5):1305-11. doi: 10.1378/chest.113.5.1305.
Malignant pleural effusions are a common problem for patients with metastatic disease. Most patients are treated with tube thoracostomy and sclerotherapy, although there remains no standard approach. The purpose of this study was to compare the efficacy of bleomycin with doxycycline sclerotherapy for the treatment of malignant pleural effusions using small-bore catheters.
All patients with a symptomatic malignant pleural effusion referred for chest tube drainage and sclerotherapy over a 2-year period were considered eligible. Using image guidance, a 14F self-retaining catheter was inserted into the pleural space and connected to continuous wall suction. When drainage fell below 200 mL/d, patients were randomized to 60 U of bleomycin or 500 mg of doxycycline sclerotherapy. Response at 30 days was determined.
One hundred six patients were enrolled in the study. Fifteen men (29%) and 37 women (71%) with a mean age of 57 years received bleomycin sclerotherapy. Twenty-one of the 29 patients (72%) alive and evaluable at 30 days had successful sclerotherapy. Twenty-three men (43%) and 31 women (57%) with a mean age of 61 years received doxycycline sclerotherapy. Twenty-three of the 29 patients (79%) alive and evaluable at 30 days had successful sclerotherapy. There was no significant difference in response rates between doxycycline and bleomycin (p=0.760).
These data continue to support a role for small-bore chest drainage and sclerotherapy, although there was no significant difference in 30-day response rates between doxycycline and bleomycin.
恶性胸腔积液是转移性疾病患者的常见问题。大多数患者接受胸腔闭式引流术和硬化治疗，尽管目前尚无标准治疗方法。本研究的目的是比较使用细导管进行博来霉素与强力霉素硬化治疗恶性胸腔积液的疗效。
所有在两年期间因症状性恶性胸腔积液而接受胸腔闭式引流和硬化治疗的患者均被视为合格。在影像引导下，将一根14F的自固定导管插入胸腔并连接至持续的壁式吸引装置。当引流量降至每日200 mL以下时，患者被随机分为接受60 U博来霉素或500 mg强力霉素硬化治疗。确定30天时的反应情况。
106例患者纳入本研究。15名男性（29%）和37名女性（71%），平均年龄57岁，接受博来霉素硬化治疗。在30天时存活且可评估的29例患者中，有21例（72%）硬化治疗成功。23名男性（43%）和31名女性（57%），平均年龄61岁，接受强力霉素硬化治疗。在30天时存活且可评估的29例患者中，有23例（79%）硬化治疗成功。强力霉素和博来霉素的反应率无显著差异（p = 0.760）。
这些数据继续支持细导管胸腔引流和硬化治疗的作用，尽管强力霉素和博来霉素在30天反应率上无显著差异。
