Utilization of talc pleurodesis via thoracoscopy in the treatment of refractory malignant pleural effusion

doi:10.3969/j.issn.2095-4344.2014.47.025

Abstract

Abstract:

BACKGROUND: Although thoracoscopy wiith pleurodesis is regarded as a positive and effective way for the treatment of malignant pleural effusion, the merit and demerit of sclerosants are directly related to postoperative recovery and the success of pleurodesis.
OBJECTIVE: To evaluate the therapeutic effect of talc pleurodesis via thoracoscopy in the treatment of refractory malignant pleural effusions
METHODS: There were 14 male and 15 female patients in this study, age ranging from 38 to 79 years. All patients with refractory malignant pleural effusion underwent talc pleurodesis under thoracoscopy. The postoperative adverse reactions, chest CT scan 1 month after operation and the fluid drainage were observed.
RESULTS AND CONCLUSION: Twenty-nine patients with chest pain were observed in this study. Eighteen patients could relieve the pain itself without medications, eight patients required oral Tramadol and three patients took Demerol or morphine orally to ease the pain. Fever occurred in three cases at 3 days after operation. Neither pneumonedema, acute respiratory failure, nor death ocurred postoperatively. One month later, complete successful pleurodesis was achieved in 24 cases, and partial successful in 3 cases, and unsuccessful in 2 cases. The results indicate that thoracoscopy with talc pleurodesis can be regarded as a positive and effective way for the treatment of malignant pleural effusion.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: thoracoscopes, pleurodesis, pleural effusion, malignant

CLC Number:

R318

Wang Zuo-pei, Wei Hai-tao, Zhang Feng, Zhang Hai-feng, Hu Bao-li. Utilization of talc pleurodesis via thoracoscopy in the treatment of refractory malignant pleural effusion[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(47): 7683-7688.

Figures/Tables 1

2.1 参与者数量分析按意向性分析，纳入29例顽固性恶性胸腔积液患者全部进入结果分析。 2.2 滑石粉硬化材料治疗结果有效24例，显效3例，无效2例，总有效率为93%(27/29)。全组患者术后均顺利拔除胸管，平均带管时间4.3(3.1-7.8) d。术后平均引流量940 (680-2 140) mL，术后第1个24 h引流量为580 (510-780) mL。 2.3 不良反应全组患者术后均出现胸痛，不需镇痛药治疗可自行缓解患者18例，占62%；需口服曲马多治疗患者8例，占28%；需口服吗啡或注射杜冷丁或吗啡患者3例，占10%。使用镇痛药超过3 d者4例，占14%；使用镇痛药超过5 d者1例，占3%。术后3 d后出现发热者3例，占10%，3例实验室检查白细胞及中性粒细胞均升高，其中2例影像学检查无明显肺部感染影像，临床症状为干咳，给予口服消炎痛片12.5 mg，每12 h 1次，口服后体温即稳定，连服3 d后停药，发热未再出现；1例影像学检查有肺部感染迹象，临床亦出现咳嗽、黄痰等感染迹象，给予继续抗生素治疗，同时行痰培养，抗感染治疗3 d后体温未再升高，实验室检查白细胞及中性粒细胞恢复正常，停药后未再反复。全组无肺水肿、急性呼吸窘迫综合征等严重并发症发生，无死亡病例。 2.4 典型病例女性左肺腺癌并双肺多发转移并左侧胸腔及心包积液患者，入院后行左侧胸腔及心包引流，全身性静脉辅助化疗，化疗方案为紫杉醇+顺铂，化疗1个周期后心包及胸腔积液均消失，拔除引流管，总共化疗6个周期，化疗中间患者复查未发现再发胸腔积液。发病11个月时患者感胸闷，复查发现左侧大量胸腔积液，行胸腔闭式引流并胸腔灌注顺铂50 mg 3次，积液量每日仍有300 mL以上，持续10 d以上，遂行手术治疗，术中发现胸膜大量米粒样结节，应用电刀烧灼处理，然后行胸膜摩擦后喷洒滑石粉。图1A，B为复查时，可以看到双肺多发占位并左侧大量胸腔积液；图1C显示为细管胸腔积液引流中，通过引流管行胸腔灌注化疗；图1D显示为术后第5天，患者每日引流量约50 mL，胸管拔出后行胸部CT，从CT可以看到左侧胸腔少量积液；图1E显示为术后1个月复查胸部CT，显示积液量较拔管后无明显变化，证明积液并未继续增长。女性弥漫性胸膜间皮瘤并胸腔积液患者，最早因左侧大量胸腔积液入河南大学淮河医院行胸腔引流，胸水查脱落细胞考虑胸膜间皮瘤诊断，患者又至郑州大学第一附属医院、北京协和医院会诊病理，均考虑胸膜间皮瘤诊断。在河南大学淮河医院应用顺铂50 mg+白细胞介素2行胸腔灌注化疗4次后，胸水不再生长，建议患者后续治疗，患者拒绝。定期复查至发病4年发现左侧再次出现胸水，再次行胸水引流，并应用顺铂50 mg+白细胞介素2(100×104 U)行胸腔灌注化疗3次，每日胸水量仍大于500 mL，遂行手术治疗。术中发现胸膜大量结节，最大直径约5 cm，应用电刀烧灼处理，然后行胸膜摩擦后喷洒滑石粉。图2A为胸水引流中，从CT可以看到胸膜增厚，术中探查为间皮瘤组织；图2B为术后拔除胸管1个月后复查，可见胸膜仍有增厚，胸腔少量积液；图2C为术后3个月，与图2B相比积液无明显变化，证明胸水未再增长。"

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