Sahn S A
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, USA.
Clin Chest Med. 1998 Jun;19(2):351-61. doi: 10.1016/s0272-5231(05)70082-4.
Malignancy is one of the most common causes of exudative effusions and increases in incidence in the elderly. Lung cancer is the most common cause of malignant effusion caused by contiguous spread and its propensity to invade the pulmonary vasculature and embolize to the visceral pleura. Lung, breast, ovary, and gastric cancer and lymphomas account for about 80% of all malignant effusions. Dyspnea and cough are the most common symptoms at presentation. Thirty percent of patients have a low pleural fluid pH (> or = 7.30) and glucose (> 60 mg/dL) at presentation, which predicts a decreased survival, an increase yield on diagnostic studies, and a poor response to chemical pleurodesis. Talc by poudrage or slurry is the most successful pleurodesis agent. Pleural peritoneal shunt is an option for patients with an intractable, symptomatic malignant effusion who cannot undergo or who have failed pleurodesis.
恶性肿瘤是渗出性胸腔积液最常见的病因之一，且在老年人中的发病率呈上升趋势。肺癌是因连续性扩散导致恶性胸腔积液最常见的病因，其易于侵犯肺血管并栓塞至脏层胸膜。肺癌、乳腺癌、卵巢癌、胃癌及淋巴瘤约占所有恶性胸腔积液的80%。呼吸困难和咳嗽是最常见的临床表现。30%的患者在就诊时胸腔积液pH值较低（≥7.30）且葡萄糖含量较高（>60mg/dL），这预示着生存率降低、诊断性检查阳性率增加以及对化学性胸膜固定术反应不佳。经粉撒法或悬液法使用的滑石粉是最成功的胸膜固定剂。对于有顽固性、有症状的恶性胸腔积液且无法接受或胸膜固定术失败的患者，胸膜腹膜分流术是一种选择。
