超声引导下小口径电凝导管插入术用于恶性胸腔积液的快速硬化治疗。

Hsu W H, Chiang C D, Chen C Y, Kwan P C, Hsu J Y

Division of Chest Medicine, Taichung Veterans General Hospital, Taiwan.

Jpn J Clin Oncol. 1998 Mar;28(3):187-91. doi: 10.1093/jjco/28.3.187.

BACKGROUND

Traditional pleurodesis for malignant pleural effusion is performed by large-bore chest tube insertion with the instillation of sclerosing agents after the compressed lung re-expansion and pleural fluid drainage of 100-150 ml/day. This study was carried out to evaluate the possibility of rapid sclerotherapy for malignant pleural effusions by insertion of a small-bore Elecath tube (12-French) under ultrasound guidance and intrapleural injection of bleomycin 60 IU.

METHODS

Twenty-six patients, with 28 cytopathologically proven malignant pleural effusions (two patients had bilateral pleural effusions) and receiving the insertion of the Elecath tube for drainage, were included in our series. This rapid and short-term sclerosing method was performed and completed by intrapleural injection of bleomycin when the pleural effusion had been clearly drained by the small-bore Elecath tube and the compressed lung had fully re-expanded on follow-up chest radiographs.

RESULTS

Twenty patients with 22 pleural effusions underwent the intrapleural injection of bleomycin, with the results of pleurodesis being complete response 41% (9/22), partial response 36% (8/22) and failure 23% (5/22). Interestingly, among the 17 successful procedures of pleurodesis (complete response and partial response), 71% (12) procedures could be completed within 2 days (seven within one day and five within 2 days). The remaining unsuccessful procedures carried out on six patients without the injection of bleomycin were due to a non-re-expanded lung (n = 3) and inadequate drainage (n = 3); of these, four patients also received the large-bore chest tube insertion after the removal of the Elecath tube, but the compressed lung still could not re-expand. The complications of the bleomycin injection were fever [77% (17/22)], vomiting [14% (3/22)] and hiccup [5% (1/22)].

CONCLUSION

The method of rapid sclerotherapy for malignant pleural effusions by small-bore Elecath tube is promising, with a success rate achieving 77%, usually within 2 days.

背景

恶性胸腔积液的传统胸膜固定术是在压缩肺复张且胸腔积液每日引流量为100 - 150 ml后，通过大口径胸管置入并注入硬化剂来进行的。本研究旨在评估在超声引导下插入小口径Elecath管（12法式）并胸腔内注射60 IU博来霉素对恶性胸腔积液进行快速硬化治疗的可能性。

方法

本研究纳入了26例患者，其28处胸腔积液经细胞病理学证实为恶性（2例患者为双侧胸腔积液），并接受了Elecath管置入引流。当小口径Elecath管已清晰引流出胸腔积液且在后续胸部X线片上压缩肺已完全复张时，通过胸腔内注射博来霉素来实施并完成这种快速短期硬化方法。

结果

20例患者的22处胸腔积液接受了胸腔内博来霉素注射，胸膜固定术结果为完全缓解41%（9/22），部分缓解36%（8/22），失败23%（5/22）。有趣的是，在17例成功的胸膜固定术（完全缓解和部分缓解）中，71%（12例）可在2天内完成（7例在1天内，5例在2天内）。其余6例未注射博来霉素的患者手术失败，原因是肺未复张（n = 3）和引流不充分（n = 3）；其中，4例患者在拔除Elecath管后还接受了大口径胸管置入，但压缩肺仍无法复张。博来霉素注射的并发症有发热[77%（17/22）]、呕吐[14%（3/22）]和打嗝[5%（1/22）]。