胸腔镜滑石粉胸膜闭锁对恶性胸腔积液的治疗效果和影响因素

Treatment outcome and influence factor of thoracoscopy talc pleurodesis

目的探讨经胸腔镜滑石粉胸膜固定术连用简易负压吸引对恶性胸腔积液的治疗效果及胸水葡萄糖(Glu),癌胚抗原(CEA),乳酸脱氢酶(LDH)对胸膜闭锁效果的影响作用。方法临床确诊的恶性胸腔积液108例,局麻下以硬质胸腔镜行开放性检查。病例随机分为两组。治疗组56例,在闭式引流基础上联用负压抽吸装置治疗,其他治疗与对照组相同。对照组52例。观察期间所有病例均接受对症支持治疗,不予以全身化疗。观察比较两组临床疗效,生活质量及胸水Glu、CEA、LDH和胸膜病变程度对治疗效果的影响。结果治疗组平均拔管时间(58.2±16.8)h较对照组(110.6±24.5)h缩短。两组之间差异有显著性(P<0.01)。治疗组排液量(780±140)ml较对照组(960±160)ml减少有显著性差异(P<0.05)。治疗组拔管后胸膜包裹及中重度胸膜肥厚的发生率较对照组显著降低。完全缓解率治疗组为89.3%,对照组为75.4%,两组比较差异有显著性(P<0.01)。胸水CEA、LD、Glu对胸膜固定术的影响无统计学意义。结论①经胸腔镜滑石粉喷撒法胸膜闭锁治疗恶性胸腔积液有肯定的疗效。②负压抽吸技术可以提高胸膜闭锁患者的生活质量,减少中重度胸膜肥厚的发生率,缩短胸膜闭式引流的时间,减少皮下气肿的发生率。③简易负压抽吸装置在胸膜闭锁术中疗效确切,简单方便,可提高临床应用价值。④胸水Glu对胸膜闭锁治疗效果的影响有统计学意义(P<0.05)。胸水Glu值的高低与胸膜病变程度相关。胸膜病变程度重,胸水Glu值低。

Objective To analyse the efficacy of talc thoracoseopic pleuraldesis（TTP）. A retrospective study was carried out on follow-up, who received TTP for treating the malignant pleural effusions. Methods A total of 108 patients underwent TTP for recurrent malignant pleural effusion. The first 56 patients（group Ⅰ ） were treated with tube drainage after TTP plus suction under negative pressure. Another 52 patients（group Ⅱ） were treated by tube drainage only. Results There were no severe intraoperative or postoperative complications. The drainage tube was removed after （58.2 ± 16.8）h, while （ 110.6 ± 24.5） h of group Ⅱ, The time in patients of Ⅰ was shorter significantly than in group Ⅱ （P 〈0.01）. The fluid amout drained from group Ⅰ [ （780 ± 140）ml] was more than group Ⅱ [ （960 ± 160）ml]. There was significant difference between two groups （P〈0.05）. The occurrence of pleura thickening was significantly lower in group Ⅰ than in group Ⅱ.The remissive rate m group Ⅰ was 89.3 %, and in group Ⅱ was 75.4 %. There was significant difference between two groups （P 〈 0, 01 ）. The pleural fluid carcinoembryonic antigen（CEA） and lactate dehydragenase（LDH） had little value for evaluating the outcome of pleurodesis. Conclusions ①Videothoracoscopic pleurodesis （talc insufflation）as a simple and efficient procedure seems to be the good alternative treatment regimen for pleural effusion. ②The suction under negative pressure can shorten the time of drainage and lower the occurrence of pleura thickening. ③The pleural fluid Glu of the patients who acquired complete recover（CR） is statistically higher than those with partial recover（PR） or non- exacerbation（NE）. And the severity of pleural disease correlates to pleural fluid Glu.