闭式引流联合尿激酶及黏连剂治疗恶性包裹性胸腔积液

Combination of closed thoracic drainage with urokinase and adhesive for malignant loculated pleural effusion

目的观察胸腔中心静脉导管闭式引流联合尿激酶及黏连剂治疗恶性包裹性胸腔积液的疗效。方法20例恶性包裹性胸腔积液患者,行胸腔中心静脉导管闭式引流,胸水引流完全后,胸腔注入尿激酶10万U闭管4 h,再打开引流装置持续引流,胸水引流完全后胸腔注入黏连剂博来霉素。结果20例中19例显效,1例有效。显效患者中4例胸膜轻度肥厚及肋隔角变钝,2例有中度肥厚黏连,显效患者控制胸水平均时间为（21.3±7.0）d。随访2-12个月,19例显效患者胸水未再发,1例有效患者胸水量未再增多。结论胸腔中心静脉导管闭式引流联合尿激酶和黏连剂治疗恶性胸腔积液方便、有效、微创及安全。

Objective To observe the therapeutic effects of closed thoracic drainage combined with urokinase and adhesive for malignant loculated pleural effusion. Methods 20 patients with malignant loculated pleural effusion were treated with closed thoracic drainage by central venous catheter. After complete drainage of pleural effusion 100 000 U urokinase were injected through thoracic cavity, and then closed tube for 4 hours. After 4 hours, open the drainage tube. When the effusion were drained completely,the bleomycin was injected for adhere the pleural. Results 19 patients achieved complete remission（CR）, and 1 case achieved partial remission （PR） in all patients. 4 of 19 CR patients with mild pachynsis pleurae and blunt costo-phrenic angle ;2 of 19 CR patients with moderate pachynsis pleurae and adhesions . The average time of control pleural effusion was （21.3 ± 7 ）days . 19 CR patients did not appeared recurrent pleural effusion. 1 PR patient with no increased pleural effusion. Conclusion Combination of closed thoracic drainage with urokinase and adhesive is a convenient, effective, minimally and safely therapeutic method for the malignant loculated pleural effusion.