B超引导下放置小孔引流管治疗恶性胸腔积液的可行性研究

目的探讨B超引导下放置小孔引流管治疗恶性胸腔积液的可行性。方法选确诊的恶性胸腔积液患者99例,随机分成两组。B超小孔引流管组(n=53)在B超引导沿肋间或下肋上缘垂直将12-Fr胸腔引流管放入胸膜腔;常规大孔引流管组(n=46)CT、胸片定位,沿肋间或下肋上缘垂直将20-Fr胸腔引流管放入胸膜腔。连接胸腔引流瓶,引流液减少至50~100 ml/d,拔出引流管,应用榄香烯乳100 ml行胸膜黏连术。对比观察两组的临床效果、操作时间、并发症和副作用。结果 B超小孔引流管组操作时间短于常规大孔引流管组,差异有显著性(P0.05),两组总有效率、引流管放置时间、住院时间、并发症发生率无显著差异(P0.05)。结论 B超引导下放置小孔胸腔引流管治疗恶性胸腔积液具有创伤小、操作简便安全、疗效肯定等优点,可作为临床上微创治疗恶性胸腔积液的一种方法使用。     

滑石粉硬化材料在胸腔镜胸膜固定治疗顽固性恶性胸腔积液中的应用

背景：胸腔镜胸膜固定为恶性胸腔积液公认的积极有效治疗手段,硬化剂的优劣直接关系胸膜固定的成功与否,关系到术后的恢复。目的：探讨滑石粉法胸腔镜胸膜固定在顽固性恶性胸腔积液治疗中的作用。方法：纳入顽固性恶性胸腔积液患者29例,其中男14例,女15例,年龄38-79岁,在双腔气管插管静脉复合麻醉下行胸腔镜胸膜固定,硬化剂选择无菌滑石粉,术后观察不良反应情况,术后1个月检查胸部CT,观察胸水量。结果与结论：29例术后均出现胸痛,自行缓解18例,需口服曲马多治疗患者8例,需口服吗啡或注射杜冷丁或吗啡患者3例。术后3 d出现发热者3例。全组无肺水肿、急性呼吸窘迫综合征等严重并发症发生,无死亡病例。术后1个月,治疗有效24例,显效3例,无效2例,总有效率为93%。表明滑石粉法胸腔镜胸膜固定为治疗顽固性恶性胸腔积液一种积极有效的手段。     

染色体检查在恶性胸腔积液诊断中的价值

目的探讨染色体检查在胸腔积液鉴别诊断中的价值。方法采用常规染色体定性检查和流式细胞术(FCM)DNA定量分析两种方法检查胸腔积液中的染色体，并进行比较。结果常规染色体检查对恶性胸腔积液诊断的特异性为98．2％，敏感性为88．9％；FCM法特异性为100％，敏感性为93．8％；二者联合的特异性为100％，敏感性为86．4％。结论常规染色体检查和FCM DNA定量分析两种方法联合检查对胸腔积液的鉴别诊断提供了可靠的诊断依据。     

胸腔镜胸膜固定术联合顺铂和鸦胆子油 治疗恶性胸腔积液疗效观察

目的探讨胸腔镜胸膜固定术联合顺铂和鸦胆子油治疗恶性胸腔积液(MPE)的临床疗效。方法将66例MPE患者平均随机分为A、B、C3组,A组接受顺铂胸膜腔内灌注治疗;B组接受胸腔镜胸膜固定术联合顺铂胸膜腔内灌注治疗;C组接受胸腔镜胸膜固定术联合顺铂及鸦胆子油胸膜腔内灌注治疗。观察并比较以上3组患者的临床治疗总有效率、Karnofsky生活质量评分(KPS)以及不良反应发生率。结果 A、B、C组治疗有效率分别为72.72%、90.90%以及95.45%,B组及C组显著高于A组(P<0.05);所有患者治疗后KPS评分均显著升高(P<0.05),治疗后B组及C组显著高于A组(P<0.05),同时C组显著高于B组(P<0.05);不良反应发生率C组显著低于A组及B组(P<0.05)。结论胸腔镜胸膜固定术联合顺铂和鸦胆子油治疗恶性胸腔积液疗效肯定,可改善患者生活质量并减轻不良反应。     

Intrapleural mitoxantrone for the palliative treatment of malignant pleural effusions

A group of 21 patients with malignant pleural effusions were treated with the instillation of 40 mg mitoxantrone intrapleurally, after complete fluid drainage. There was a 100% complete response rate with no toxic effects (0%). The mean survival of the patients was 57.1 weeks.     

临床护理路径在肺癌合并恶性胸腔积液胸膜固定术治疗中的应用效果研究

[目的]研究临床护理路径在肺癌合并恶性胸腔积液胸膜固定术治疗中的应用效果。[方法]选择我院确诊的肺癌合并恶性胸腔积液的病人62例随机分为对照组和观察组,每组31例,两组病人均予以胸膜固定术进行治疗,对照组予以常规护理措施,观察组按临床护理路径表予以护理措施。对两组病人的心理状况总分、护理满意率及术后生活质量评分进行比较分析。[结果]62例病人手术均获成功。术后对照组和观察组的心理状况总分分别为2．52分±0．53分、1．27分±0．31分,观察组的心理健康状况显著高于对照组（t=2．132,P〈0．05）。对照组与观察组病人满意率分别为67．7％、93．5％,观察组的满意率显著高于对照组（x2=6．61,P〈0．05）。对照组与观察纽病人生活质量改善率分别为71．0％、93．5％,观察组病人的生活质量改善率显著优于对照组（x2=5．42,P〈0．05）。[结论]临床护理路径可显著提高肺癌合并恶性胸腔积液病人的护理满意率,并改善病人术后的心理健康状况及生活质量,有利于病人的康复及后续治疗的实施。     

Rapid pleurodesis with doxycycline through a small-bore catheter for the treatment of metastatic malignant effusions

Goals of work The goal of the study was to evaluate the safety and efficacy of bedside pleurodesis with doxycycline using a short-term indwelling chest catheter for the palliative treatment of malignant effusions.Materials and methods A prospective study of 36 rapid pleurodesis procedures in 34 patients with malignant pleural effusions was conducted over a 5-year period in a university hospital. A 12F chest catheter placement was facilitated utilizing the Seldinger percutaneous entry technique. Patients received 500 mg of intrapleural doxycycline combined in half of the cases with mepivacaine. We assessed success or failure of pleurodesis in addition to the frequency of complications and survival.Main results Chest tubes were removed within 24 h in 69% and within 48 h in 94% of the patients. Complete success of pleurodesis was achieved in 17 (55%), partial success in eight (26%), and failure in six (19%) out of 31 evaluative procedures. Thus, the overall success rate of pleurodesis was 81%. Toxicity was mild and included pain (36%), fever (8%), and pneumothorax (6%). The median survival was 105 days. There was no relationship between instillation of intrapleural anesthetics and development of pain.Conclusions Rapid pleurodesis with doxycycline, which can be accomplished within 24 to 48 h, is a valid option for the symptomatic treatment of malignant effusions. This technique can be used as a first-line procedure in the majority of cases, particularly if thoracoscopic facilities are not available.     

应用电视纵隔镜诊治恶性胸腔积液

目的探讨电视纵隔镜在恶性胸腔积液诊治中的应用价值。方法回顾性分析2003年5月～2004年10月20例行电视纵隔镜胸膜活检 滑石粉胸膜固定术治疗的恶性胸腔积液患者的资料。结果手术诊断率100.0％，有效率95．0％，全组无手术死亡。结论电视纵隔镜对恶性胸腔积液的诊断和治疗有较高的临床实用价值。     

ROC曲线评价腺苷脱氨酶在结核性、恶性胸腔积液的鉴别诊断价值

目的探讨腺苷脱氨酶（ADA）测定在结核性胸腔积液及恶性胸腔积液患者的鉴别诊断价值。方法应用受试者工作曲线（ROC）对176例结核性胸腔积液患者及162例恶性胸腔积液患者的胸腔积液ADA、血清ADA、胸腔积液ADA/血清ADA检测结果进行分析评价。结果 （1）血清ADA在两组资料间差异无统计学意义（P〉0.05）,胸腔积液ADA、胸腔积液ADA/血清ADA在两组资料间比较差异均有统计学意义（P〈0.05）,二者的敏感性分别为92.9%、71.9%,特异性分别为94.7%、100%,准确度分别为93.4%、78.6%。（2）胸腔积液ADA、胸腔积液ADA/血清ADA在ROC曲线下面积分别为0.942、0.909。胸腔积液ADA、胸腔积液ADA/血清ADA对结核性胸腔积液的临床诊断临界点分别为16.4U/L、2.57。结论胸腔积液ADA在结核性和恶性胸腔积液的鉴别中具有重要的临床价值,可作为结核性胸腔积液的生物标志物。     

Pleural fluid findings as prognostic factors for malignant pleural mesothelioma

The aim of this study was to determine the prognostic value of pleural fluid glucose, lactate dehydrogenase (LDH), albumin, total protein, and total leukocyte levels in patients with malignant pleural mesothelioma. We retrospectively analyzed 71 consecutive patients (33 men and 38 women) who were referred to the department of chest diseases in a university hospital. Pleural fluid glucose levels, the ratio of pleural fluid to serum LDH>1.0, and total leukocyte count were significant predictors for the survival in univariate analysis. However, none of these variables emerged as statistically significant from the multivariate Cox model. In conclusion, our results showed that there is an inverse correlation between the intensity of inflammation and survival.     

Video-assisted thoracoscopic pleurectomy as therapy for recurring malignant pleural effusion

Summary

Recurring malignant pleural effusion is a common problem with carcinomas invading the pleural surface. Associated symptoms like dyspnoea, cough, and arrhythmia considerably limit the patient's remaining quality of life. Numerous methods have been advocated to induce pleurodesis. The various forms of treatment range from chest tube drainage over instillations of sclerosing substances like tetracyclines, cytostatics, and talc to pleurectomy. None of these treatments, however, so far fulfills the demands for maximum effectiveness with a low rate of recurrence and morbidity. With the introduction of video-assisted thoracoscopic pleurectomy, a method with a low rate of recurrence and morbidity is now at our disposal. During the last 18 months 21 patients with various primary tumours have undergone pleurectomy for pleural carcinomatosis in our hospital. All patients had previously been treated by other methods. In all cases of secondary pleural carcinomatosis a complete parietal pleurectomy was possible. The intra-operative loss of blood was low, with an average of 370 ml. Intra- or post-operative complications did not occur. The mean duration of chest tube drainage was 7 d and the post-operative hospital stay 12 d. During a period of 18 months we have recorded one recurrence requiring no further treatment. These results show that video-assisted thoracoscopic pleurectomy should be undertaken early when other non-invasive methods have failed.     

恶性胸腔积液的诊断 ——附114例报道

目的 探讨恶性胸腔积液的诊断方法及特点。方法 对114例恶性胸腔积液患者的诊断资料及方法进行回顾性分析。结果 110例经胸水脱落细胞学检查获得明确诊断，4例在胸腔镜下行胸膜活检而确诊。66例胸腔内留置微管排液送检，均未出现并发症；48例行胸腔穿刺排液送检，其中有9例出现气胸、复张性肺水肿、胸膜反应等并发症。结论 应对中等量以上胸腔积液患者积极进行胸水脱落细胞学检查；对于诊断困难的病例，可应用胸腔镜行胸膜活检：胸腔内留置微管可多次、随时获取标本，值得临床推广。     

Diagnostic accuracy of endostatin for malignant pleural effusion: A clinical study and meta-analysis

Background. The diagnosis of malignant pleural effusion (MPE) remains a clinical challenge. Many studies suggest that endostatin is a potential marker for MPE. This study aimed to determine the diagnostic value of endostatin with respect to MPE and to summarize the overall diagnostic performance of endostatin via a meta-analysis. Methods. Pleural effusion samples from patients with both malignant and nonmalignant disease were collected, and the pleural levels of endostatin and carcino-embryonic antigen (CEA) were subsequently measured. The diagnostic performances of endostatin and CEA were analyzed via standard receiver operator characteristic curve analysis methods, using the AUC as a measure of accuracy. The overall diagnostic accuracy of endostatin for MPE was summarized through a bivariate meta-analysis with standard method recommended. Results. Fifty-two patients with MPEs and 64 patients with benign pleural effusions (BPEs) were included this study. Pleural endostatin levels were significantly increased in the setting of MPE compared with BPE (104.78 ± 64.58 vs 56.81 ± 28.84 ng/ml; p < 0.001). Using a cutoff value of 79.7 ng/ml, the sensitivity and specificity of endostatin in diagnosing MPE were shown to be 51.92% and 85.94%, respectively, and the AUC was 0.747. The combination of endostatin and CEA enhanced diagnostic performance with respect to MPE. In addition to this study, another eight studies were included in this meta-analysis. The pooled diagnostic estimates were 0.69 for sensitivity and 0.78 for specificity. The positive likelihood ratio and negative likelihood ratio for endostatin were 3.16 and 0.40, respectively. The diagnostic odds ratio was 7.89, and the AUC of the summary receiver operator characteristic curve was 0.79. Conclusion. Pleural levels of endostatin are increased in the setting of MPE. However, endostatin exhibits a limited efficacy for the diagnosis of MPE and shows a relatively low sensitivity. The assessment of endostatin in combination with CEA may enhance diagnostic accuracy with respect to MPE.     

经可弯曲内科胸腔镜干粉状滑石粉胸膜固定术治疗恶性胸腔积液

目的探讨可弯曲内科胸腔镜滑石粉胸膜固定术治疗恶性胸腔积液的临床疗效。方法回顾性分析9例恶性胸腔积液患者行胸膜固定术的临床资料。结果7例粘连良好,有效率77.8%(7/9)。滑石粉用量2～3g。胸痛4例,发热3例,对症治疗1、2d缓解,无严重并发症。结论可弯曲内科胸腔镜干粉状滑石粉胸膜固定术是一种安全、有效地治疗恶性胸腔积液的方法。     

负压防反流技术联合白介素-2治疗恶性胸腔积液的临床研究

目的观察负压防反流技术联合白介素-2(IL-2)治疗恶性胸腔积液临床疗效及安全性。方法 196例恶性胸腔积液患者随机分为3组:A组应用负压防反流装置,将胸腔积液引流干净注入IL-2;B组应用胸腔置中心静脉导管引流胸水,无胸水流出时注入IL-2;C组应用胸腔穿刺抽液,至不能抽出胸水时注入IL-2。比较3组患者临床疗效及安全性。结果 A组136例患者胸水治疗总有效率明显高于B、C组;而1年、2年、3年无胸水生存率明显高于B、C组;所有患者耐受良好,无严重毒副反应及并发症。结论负压反流技术联合IL-2治疗恶性胸腔积液有效率及安全性高,值得临床普遍推广应用。     

中心静脉导管在56例恶性胸腔积液患者持续引流中的护理体会

目的探讨中心静脉导管应用于恶性胸腔积液患者的护理。方法选择56例胸腔积液患者置入中心静脉导管。结果有7例患者置管处疼痛后拔管,其余患者均达到治疗周期,未发生其他置管并发症。结论恶性胸腔积液患者胸腔置入中心静脉导管后,实施有效的护理措施能够保证治疗顺利进行,并减少多次胸腔穿刺的痛苦。