碘伏胸膜固定术与胸腔镜滑石粉胸膜固定术治疗恶性胸腔积液的对比研究  

Local Iodine Pleurodesis Versus Thoracoscopic Talc Insufflation in Recurrent Malignant Pleural Effusion: a Prospective Randomized Control Trial

作　　者：李玉嶂[1,2] 韩敬泉[1] 曹守强[1] 董庆[1] 赵桂彬[1] 崔键[1] 

机构地区：[1]哈尔滨医科大学附属第四临床医学院胸外科,黑龙江哈尔滨150001 [2]黑龙江省医院胸外科,黑龙江哈尔滨150030

出　　处：《现代生物医学进展》2016年第14期2721-2724,共4页Progress in Modern Biomedicine

基　　金：哈尔滨市科技局青年后备人才基金资助项目(2015RAQYJ095);黑龙江省科技厅应用技术研究与开发计划项目(GA14C101)

摘　　要：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 outcome of thoracoscopic talc poudrage （TTP） versus povidone-iodine pleurodesis （PIP） through a thoracostomy tube as a palliative treatment of pleural effusion due to metastatic breast carcinoma （MBC）. Methods： A total of 42 MBC patients were prospectively enrolled in a randomized controlled trial. All patients had moderate to severe dyspnea （（MRC） dyspnea scale III-V ）. Twenty-two patients received TTP （group A）, whereas 20 patients （group B） underwent pleurodesis by instilling povidone-iodine through a thoracostomy tube, as a bedside procedure. The pleurodesis success rate, ease breathing difficulties, the hospital stay as well as chest pain, fever was detected and compared between two groups before and after treatment. Results： The pleurodesis success rate had no significant difference between the two groups （91% vs 85 %, P = 0.9）, and the morbidity in both groups was low. Post-procedure analgesic requirements due to severe pleuritic chest pain were higher in group A （18 % vs 0, P=0.2）. Four patients in group A （18 %） and one in group B （5 %） were febrile （〉38 degrees C） within 48 h of the procedure. Both groups achieved good symptom control, with improvement in MRC dyspnea scale （ I - II ）, no significant difference between the two groups （P〉0.05）. There were no in-hospital deaths. The post-procedure hospital stay was lower in group B （P=0.009）. The mean progression-free interval was 6.6 （mnge 3-15） months. At follow-up, the recurrence of significant pleural effusion requiring intervention was noted in two and three patients in group A and group B, respectively （P〉0.05）. Conclusions： Povidone-iodine can be considered as a good alternative to TTP to ensure effective pleurodesis for patients with malignant pleural effusion due to MBC. The drug is available, safe and not expensive, can be given through a thomcostomy tube and can be repeated if necessary.

关 键 词：乳腺癌 胸腔积液 胸膜固定 聚合碘 滑石粉 

分 类 号：R737.9[医药卫生—肿瘤] R605[医药卫生—临床医学]