论文部分内容阅读
目的:对乳腺癌胸腔转移的恶性胸腔积液的患者,通过使用胸腔镜滑石粉喷洒和通过胸导管注入聚合碘行胸膜固定术,比较两种方法的有效性、安全性及成功率。方法:42个乳腺癌胸腔转移的恶性胸腔积液的患者纳入了此项前瞻性随机对照研究。所有患者都有中度至重度呼吸困难(MRC呼吸困难量表Ⅲ-Ⅴ级)。22个患者完成胸腔镜滑石粉胸膜固定术(A组),而20例(B组)在床旁完成胸腔注入聚合碘。比较两组患者胸膜固定的成功率,呼吸困难缓解情况,住院时间以及胸痛、发热等并发症发生情况。结果:胸膜固定术成功率两组无明显差异(91%vs 85%,P=0.9),术后并发症两组均较低。手术后,因胸膜炎性胸痛需要止痛处理的A组明显高于B组(18%vs 0,P=0.2)。手术后48小时内,A组患者中有4个病人(18%),B组中1个患者(5%)出现发热(>38℃)。治疗后两组呼吸困难症状得到了较好的控制,呼吸困难程度为(Ⅰ-Ⅱ),但两组之间无统计学差异(P>0.05)。没有患者在医院内死亡。术后B组患者的住院时间更短(P=0.009)。平均症状无进展时间隔为6.6(范围3-15)月。随访中胸腔积液复发需要从新干预的A组有2例,B组3例。结论:对于乳腺癌转移性胸腔积液,聚合碘可作为胸腔镜滑石粉胸膜固定术外不错的选择。聚合碘容易获得,便宜且安全,可通过胸腔引流管给药,如果必要可以重复操作。
OBJECTIVE: To compare the efficacy, safety and success rate of two methods in patients with malignant pleural effusion of breast cancer with thoracic cavity empyema by spraying thoracoscopic talc powder and injecting polymeric iodine via thoracic duct. METHODS: Forty-two patients with malignant pleural effusion with breast-wall metastases were included in this prospective randomized controlled study. All patients had moderate to severe dyspnea (MRC Dyspnea Scale III-V). Twenty-two patients underwent thoracoscopic talc pleurodesis (group A), while 20 patients (group B) completed intrapleural injection of polymeric iodine at the bedside. The success rate of pleurodesis, relief of dyspnea, length of hospital stay, and complication of chest pain and fever were compared between the two groups. Results: The success rate of pleurodesis was no significant difference between the two groups (91% vs 85%, P = 0.9). Postoperative complications were lower in both groups. After surgery, the group A required analgesia due to pleuritic chest pain was significantly higher than the group B (18% vs 0, P = 0.2). Within 48 hours after surgery, 4 patients (18%) in group A and 1 (5%) in group B developed fever (> 38 ° C). After treatment, the symptoms of dyspnoea in both groups were well controlled and the degree of dyspnea was (Ⅰ-Ⅱ), but there was no significant difference between the two groups (P> 0.05). No patient died in the hospital. Postoperative patients in group B had shorter hospital stays (P = 0.009). Mean symptom progression free interval was 6.6 (range 3-15) months. Follow-up of pleural effusion recurrence requires a new intervention in the A group of 2 cases, B group of 3 cases. CONCLUSIONS: Polymeric iodine is a good alternative to thoracoscopic talc pleurodesis for metastatic pleural effusions of breast cancer. Polymeric iodine is readily available, inexpensive and safe, can be administered through the chest drain, and repeated if necessary.