用内科胸腔镜进行滑石粉胸膜固定术治疗恶性胸腔积液27例临床分析

Medical thoracoscopic talc pleurodesis for malignant pleural effusion:an analysis of 27 cases

目的:采用可弯曲式内科胸腔镜对恶性胸腔积液患者进行胸膜固定术,观察其疗效和安全性。方法:分析2005年7月至2007年9月间接受可弯曲式内科胸腔镜滑石粉胸膜固定术的27例恶性胸腔积液患者,总结其临床特点、随访手术疗效、不良反应。结果:27例患者中,男性16例,女性11例,平均年龄65.2岁,腺癌16例,恶性间皮瘤6例,鳞癌2例,小细胞肺癌1例,淋巴上皮样癌1例,未分化癌1例。随访30d以上,粘连完全成功22例,部分粘连4例,粘连未成功1例,总有效率为96.3(26/27)。平均拔管时间为6.85d(3～14d)。19例(70.4,19/27)发生术后胸痛,21例(77.8,21/27)术后出现发热,12例(44.4,12/27)术后外周血白细胞升高。所有患者术后呼吸困难症状均减轻,无急性肺损伤发生。结论:用内科胸腔镜进行滑石粉胸膜固定术是一种安全、有效的恶性胸腔积液姑息治疗方法,术前对患者情况进行充分的评价可提高治疗的成功率。

Objective：To evaluate the efficacy and safety of talc poudrage pleurodesis via semi-rigid medical thoracoscopy in the treatment of malignant pleural effusions, as well as the factors that may influence the outcomes. Methods： A series of 27 patients with malignant pleural effusion underwent medical thoracoscopic talc poudrage pleurodesis between July 2005 and September 2007 in Peking University First Hospital. Results： There were 16 male and 11 female patients in the series, the average age being 65.2 years. All the patients had documented malignant pleural effusions, including 16 cases of adenoearcino- ma, 6 of malignant mesothelioma, 2 of squamous cell carcinoma, 1 of lymphoepithelioma-like carcinoma, 1 of small cell carcinoma and 1 of undifferentiated lung cancer. Thirty days after the procedures, complete successful pleurodesis was achieved in 22 cases, and partial successful in 4 cases. Pleurodesis was not successful in one case. Overall successful rate was 96.3% （26/27）. The average duration of thoracic tubing was 6.85 days. Chest pain, fever and an increase in peripheral WBC after the procedure occurred in 19（70.4%, 19/27）, 21 （77.8%, 21/27）, and 12（44.4%, 12/27）eases respectively. No respiratory failure occurred. Conclusion： Medical thoracoscopic talc poudrage pleurodesis is a safe and effective method for the treatment of malignant pleural effusion.